Healthcare Provider Details

I. General information

NPI: 1619203197
Provider Name (Legal Business Name): JUDY L THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 MOURSUND ST ROOM A220
HOUSTON TX
77030-3405
US

IV. Provider business mailing address

1333 MOURSUND ST ROOM A220
HOUSTON TX
77030-3405
US

V. Phone/Fax

Practice location:
  • Phone: 713-797-5945
  • Fax: 713-797-5982
Mailing address:
  • Phone: 713-797-5945
  • Fax: 713-797-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberN2315
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: