Healthcare Provider Details

I. General information

NPI: 1619905502
Provider Name (Legal Business Name): THOMAS ALEXANDER JR SERVICES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 OLYMPIC PLAZA CIR STE 850 SOUTHWESTERN CEREBRAL CIRCULATORY DYNAMICS
TYLER TX
75701-1955
US

IV. Provider business mailing address

PO BOX 6813
TYLER TX
75711-6813
US

V. Phone/Fax

Practice location:
  • Phone: 903-592-8685
  • Fax: 903-597-3129
Mailing address:
  • Phone: 903-592-8685
  • Fax: 903-597-3129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: