Provider Demographics
NPI:1487756417
Name:PERRY, THOMAS C (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:PERRY
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:P.O. BOX 359
Mailing Address - Street 2:9971 OLD BATSON SARATOGA RD.
Mailing Address - City:SOUR LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:77659-0359
Mailing Address - Country:US
Mailing Address - Phone:409-287-2570
Mailing Address - Fax:409-924-9696
Practice Address - Street 1:9971 OLD BATSON SARATOGA RD
Practice Address - Street 2:
Practice Address - City:SOUR LAKE
Practice Address - State:TX
Practice Address - Zip Code:77659
Practice Address - Country:US
Practice Address - Phone:409-287-2570
Practice Address - Fax:409-924-9696
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6233207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK6233OtherTX MEDICAL BOARD PERMIT
TXK6233OtherTX MEDICAL BOARD PERMIT