MEDICARE: THOMAS JOE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	H2496	TX
2	208D00000X	General Practice Physician	H2496	TX

General Provider Information

NPI Number	:	1003161530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JOE M.D.

Provider Business Mailing Address
First Line	:	3909 ACAPULCO ST
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-6513
Country	:	US
Telephone Number	:	972-383-9107
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 ACAPULCO ST
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-6513
Country	:	US
Telephone Number	:	972-383-9107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	08/06/2012

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