Provider Demographics
NPI:1669466694
Name:THOMAS, TIMOTHY KEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:KEVIN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 SOUTHWEST PKWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4145
Mailing Address - Country:US
Mailing Address - Phone:940-687-8000
Mailing Address - Fax:940-687-7005
Practice Address - Street 1:2945 SOUTHWEST PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4145
Practice Address - Country:US
Practice Address - Phone:940-687-8000
Practice Address - Fax:940-687-7005
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3850208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114474304Medicaid
TX114474304Medicaid
TX00499HMedicare PIN