MEDICARE: MR. THOMAS ARTHUR SMALL PA-C

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	363A00000X	Physician Assistant	PA04322	TX

General Provider Information

NPI Number	:	1275568792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS ARTHUR SMALL PA-C

Provider Business Mailing Address
First Line	:	132 LACELEAF LN
Second Line	:
City	:	CIBOLO
State	:	TX
Zip	:	78108-3153
Country	:	US
Telephone Number	:	210-945-4972
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 LACELEAF LN
Second Line	:
City	:	CIBOLO
State	:	TX
Zip	:	78108-3153
Country	:	US
Telephone Number	:	210-945-4972
Fax Number	:

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

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

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