Provider Demographics
NPI:1063417822
Name:ALSTON, THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:ALSTON
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 1:1400 COLLEGE DR
Mailing Address - Street 2:STE 202
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503
Mailing Address - Country:US
Mailing Address - Phone:903-735-5330
Mailing Address - Fax:
Practice Address - Street 1:1400 COLLEGE DR
Practice Address - Street 2:STE 202
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3575
Practice Address - Country:US
Practice Address - Phone:903-735-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR90455OtherAR BLUE CROSS BLUE SHIELD
TX80330YOtherTEXAS BLUE CROSS BLUE SHI
B20882Medicare UPIN
TX8777J0Medicare ID - Type Unspecified