Basic Information
| Provider Information | |||||||||
| NPI: | 1093709776 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VOLATILE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 846098 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033246450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1327 TROUP HWY | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757014443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035108840 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 10/14/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | CI-0006680 | DE | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | TEMPORARY | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | M8405 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0000307901 | 05 | DE | MEDICAID | 510383254 | 01 | DE | BLUE SHIELD | OTHER | 77741 | 01 | TX | PHCS | OTHER | 8AM680 | 01 | TX | BCBS OF TEXAS | OTHER | TIN PLUS SUFFIX 021 | 01 | TX | TRICARE | OTHER | 280888 | 01 | MAMSI | OTHER | 2948060 | 01 | AETNA HMO | OTHER | 42228102 | 01 | CAREFIRST | OTHER | 510383254 | 01 | TRAICARE | OTHER | 75-2616977-113 | 01 | TX | TRICARE | OTHER | G2420012 | 01 | DELMARVA HEALTH PLAN | OTHER | A57187 | 01 | MID ATLANTIC | OTHER | 4501628 | 01 | AETNA NON HMO | OTHER | TIN PLUS SUFFIX 016 | 01 | TX | TRICARE | OTHER |