MEDICARE: THOMAS L DOUTHIT D.D.S.

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	1223G0001X	General Practice Dentistry	10763	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	UNITED CONDORDIA	OTHER	TX	551157

General Provider Information

NPI Number	:	1255420048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS L DOUTHIT D.D.S.

Provider Business Mailing Address
First Line	:	5975 FM 78
Second Line	:	SUITE 360
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1003
Country	:	US
Telephone Number	:	210-661-4212
Fax Number	:

Provider Business Practice Location Address
First Line	:	5975 FM 78
Second Line	:	SUITE 360
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1003
Country	:	US
Telephone Number	:	210-661-4212
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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