Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0101055420 | VA |
N | 208600000X | Surgeon | 0101055420 | VA |
N | 2086S0127X | Trauma Surgeon | 056062 | GA |
Y | 2086S0127X | Trauma Surgeon | N3048 | TX |
NPI | 1255320594 |
---|---|
Provider Name | Dr. Thomas John Goaley JR. |
First Address | Dallas, TX 75284-7408 |
Second Address | Waco, TX 76712-8897 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 18/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101055420 | MEDICAL LICENSE (01) | VA |
056062 | MEDICAL LICENSE (01) | GA |
18256 | MEDICAL LICENSE (01) | NE |
FG1281675 | DEA (01) | |
G0165380 | TEXAS DEPARTMENT OF PUBLIC SAFETY (01) | TX |
N3048 | TX MED BOARD LICENSE (01) | |
TEMP 10APR2009 | TEXAS MEDICAL BOARD (01) |