Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | L2672 | TX |
N | 207QA0401X | Family Doctor - Addiction Medicine | L2672 | TX |
NPI | 1053355321 |
---|---|
Provider Name | Thomas L Spain |
First Address | Dallas, TX 75235-7701 |
Second Address | Dallas, TX 75235-7701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 08/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159837702 | (05) | TX |
159837703 | (05) | TX |
159837704 | (05) | TX |
H84244 | (02) | TX |