=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902922743
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS C TURNER, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 01/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 848 CENTRAL DR
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79761-4202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-580-0246
-----------------------------------------------------
Fax | 432-580-0544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 848 CENTRAL DR
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79761-4202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-580-0246
-----------------------------------------------------
Fax | 432-580-0544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | PAM PEARSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 432-580-0246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | E6662
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------