Healthcare Provider Details

I. General information

NPI: 1881077857
Provider Name (Legal Business Name): CHARLES THOMAS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12446 WEST AVE STE 200
SAN ANTONIO TX
78216-2517
US

IV. Provider business mailing address

12446 WEST AVE STE 200
SAN ANTONIO TX
78216-2517
US

V. Phone/Fax

Practice location:
  • Phone: 210-576-5009
  • Fax: 210-579-8595
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES THOMAS
Title or Position: MD
Credential: MD
Phone: 210-525-1668