MEDICARE: THOMAS E EIDSON, PLLC

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	207QS0010X	Sports Medicine (Family Medicine) Physician	N9698	TX

General Provider Information

NPI Number	:	1528338795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS E EIDSON, PLLC

Provider Business Mailing Address
First Line	:	2705 W ARKANSAS LN
Second Line	:	SUITE A
City	:	ARLINGTON
State	:	TX
Zip	:	76016-5818
Country	:	US
Telephone Number	:	817-795-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2705 W ARKANSAS LN
Second Line	:	SUITE A
City	:	ARLINGTON
State	:	TX
Zip	:	76016-5818
Country	:	US
Telephone Number	:	817-795-7200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS E EIDSON
Credential	:	DO
Telephone Number	:	817-795-7200

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	04/30/2013

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