1740484328 NPI number — DR. SHERRIE PARKER THOMAS M.D.

Table of content: DR. SHERRIE PARKER THOMAS M.D. (NPI 1740484328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740484328 NPI number — DR. SHERRIE PARKER THOMAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
SHERRIE
Provider Middle Name:
PARKER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARKER
Provider Other First Name:
SHERRIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740484328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9000 DEER SHADOW PASS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78733-6123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-682-5540
Provider Business Mailing Address Fax Number:
512-334-2702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 E 30TH ST
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78705-3326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-505-5500
Provider Business Practice Location Address Fax Number:
512-334-2702
Provider Enumeration Date:
06/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  BP1-0016963 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 219401102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 219401103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 219401104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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