Basic Information
| Provider Information | |||||||||
| NPI: | 1386835569 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | RACHEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GEORGE | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | RACHEL | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7800 PRESTON RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750243234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726083800 | ||||||||
| FaxNumber: | 9725260741 | ||||||||
| Practice Location | |||||||||
| Address1: | 3044 OLD DENTON RD | ||||||||
| Address2: | SUITE 138 | ||||||||
| City: | CARROLLTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750075016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722450007 | ||||||||
| FaxNumber: | 9722459272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 12/06/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N6067 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 4728983315 | 01 | MYUTMB 4728983315 | OTHER | 213246602 | 05 | TX | MEDICAID | 213246601 | 05 | TX | MEDICAID | 213246603 | 05 | TX | MEDICAID | 213246604 | 05 | TX | MEDICAID |