MEDICARE: LEONARD M. THOME, M.D., P.A.

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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1700121753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEONARD M. THOME, M.D., P.A.

Provider Business Mailing Address
First Line	:	3820 HIGHWAY 365
Second Line	:	SUITE 100
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-7543
Country	:	US
Telephone Number	:	409-729-9114
Fax Number	:	409-729-9197

Provider Business Practice Location Address
First Line	:	3820 HIGHWAY 365
Second Line	:	SUITE 100
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-7543
Country	:	US
Telephone Number	:	409-729-9114
Fax Number	:	409-729-9197

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEONARD M THOME
Credential	:	M.D.
Telephone Number	:	409-729-9114

Provider Enumeration Date	:	12/03/2012
Last Update Date	:	12/03/2012

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