MEDICARE: CEALEE ANTREA THOMAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	L9513	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8R5288	OTHER	TX	BCBS PROVIDER #

General Provider Information

NPI Number	:	1962413849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CEALEE ANTREA THOMAS M.D.

Provider Business Mailing Address
First Line	:	3920 W WHEATLAND RD
Second Line	:	SUITE 108
City	:	DALLAS
State	:	TX
Zip	:	75237-3401
Country	:	US
Telephone Number	:	214-948-7779
Fax Number	:	214-948-9977

Provider Business Practice Location Address
First Line	:	2505 N HWY 360
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-7818
Country	:	US
Telephone Number	:	214-952-0829
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	10/14/2022

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