1922175827 NPI number — THOMAS LOUIS BOROK, MD, PA

Table of content: (NPI 1922175827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922175827 NPI number — THOMAS LOUIS BOROK, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS LOUIS BOROK, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922175827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 702806
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75370-2806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-931-1073
Provider Business Mailing Address Fax Number:
972-931-1073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5004 SPYGLASS DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75287-7429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-931-1073
Provider Business Practice Location Address Fax Number:
972-931-1073
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOROK
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-931-1073

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  F8420 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0001X , with the licence number: 31879 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 01053626A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 41983020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 10480 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 41983-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 897859945 . This is a "IMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: PO8820196 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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