Healthcare Provider Details

I. General information

NPI: 1093709776
Provider Name (Legal Business Name): THOMAS B VOLATILE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 TROUP HWY
TYLER TX
75701-4443
US

IV. Provider business mailing address

PO BOX 846098
DALLAS TX
75284-6098
US

V. Phone/Fax

Practice location:
  • Phone: 903-510-8840
  • Fax:
Mailing address:
  • Phone: 903-324-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberCI-0006680
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberTEMPORARY
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM8405
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: