Healthcare Provider Details

I. General information

NPI: 1730191693
Provider Name (Legal Business Name): THOMAS C. MAYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 ALAMEDA AVE
EL PASO TX
79905-2705
US

IV. Provider business mailing address

440 RAYNOLDS ST # 51015
EL PASO TX
79905-1613
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-5700
  • Fax: 915-215-8872
Mailing address:
  • Phone: 915-215-4480
  • Fax: 915-215-5386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberH1898
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: