Provider Demographics
NPI:1437248044
Name:DEBAUCHE, THOMAS LEON (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEON
Last Name:DEBAUCHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21212 NORTHWEST FWY
Mailing Address - Street 2:STE 405
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5884
Mailing Address - Country:US
Mailing Address - Phone:281-890-8588
Mailing Address - Fax:281-894-0426
Practice Address - Street 1:21212 NORTHWEST FWY
Practice Address - Street 2:STE 405
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5884
Practice Address - Country:US
Practice Address - Phone:281-890-8588
Practice Address - Fax:281-894-0426
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5884207R00000X, 207RC0000X
IDM-17309207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116077201Medicaid
060003218OtherRAILROAD MEDICARE
TX116077201Medicaid
060003218OtherRAILROAD MEDICARE