=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790804946
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL THOMAS DOCIS PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 11/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2120 ASHLAND ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008-2418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-297-6458
-----------------------------------------------------
Fax | 979-297-0076
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 OAK DR S SUITE C
-----------------------------------------------------
City | LAKE JACKSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77566-5629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-297-6458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA02855
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------