MEDICARE: THOMAS MICHAEL BOCKMAN MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	MD433424	PA
3	207R00000X	Internal Medicine Physician	N0653	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BP1-0017690	OTHER		INSTITUTIONAL PERMIT

General Provider Information

NPI Number	:	1578772471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS MICHAEL BOCKMAN MD

Provider Business Mailing Address
First Line	:	2505 WEDGLEA DR
Second Line	:	APT #234
City	:	DALLAS
State	:	TX
Zip	:	75211-2037
Country	:	US
Telephone Number	:	214-566-6537
Fax Number	:

Provider Business Practice Location Address
First Line	:	2505 WEDGLEA DR
Second Line	:	APT #234
City	:	DALLAS
State	:	TX
Zip	:	75211-2037
Country	:	US
Telephone Number	:	214-566-6537
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	02/09/2010

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