Provider Demographics
NPI:1548253503
Name:LOFTUS, THOMAS STUART (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STUART
Last Name:LOFTUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2200 PARK BEND DR.
Mailing Address - Street 2:BLDG. 2, SUITE 202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758
Mailing Address - Country:US
Mailing Address - Phone:512-836-0900
Mailing Address - Fax:512-836-0902
Practice Address - Street 1:2200 PARK BEND DR.
Practice Address - Street 2:BLDG. 2, SUITE 202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:512-836-0900
Practice Address - Fax:512-836-0902
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5439207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163319001Medicaid
TX7039435OtherAETNA
TX8H8375OtherBLUE CROSS BLUE SHIELD
8A7550Medicare PIN
TXH84811Medicare UPIN