Provider Demographics
NPI:1669413779
Name:THOMAS, M JEANINE H (DO)
Entity type:Individual
Prefix:
First Name:M JEANINE
Middle Name:H
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JEANINE
Other - Middle Name:H
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1800 W PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6105
Mailing Address - Country:US
Mailing Address - Phone:817-274-0329
Mailing Address - Fax:817-274-0127
Practice Address - Street 1:1800 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6105
Practice Address - Country:US
Practice Address - Phone:817-274-0329
Practice Address - Fax:817-274-0127
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122142605Medicaid
TXG21860Medicare UPIN
TX8D1929Medicare PIN