Healthcare Provider Details

I. General information

NPI: 1851399331
Provider Name (Legal Business Name): THOMAS F MCCLOSKEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 CLINIC DR
TYLER TX
75701-2119
US

IV. Provider business mailing address

1318 CLINIC DR
TYLER TX
75701-2119
US

V. Phone/Fax

Practice location:
  • Phone: 903-597-9622
  • Fax: 903-597-1210
Mailing address:
  • Phone: 903-597-9622
  • Fax: 903-597-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number988
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0988
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: