Provider Demographics
NPI:1306886353
Name:TRESE, THOMAS J (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:TRESE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 OAKBEND TRL
Mailing Address - Street 2:SUITE 175
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3912
Mailing Address - Country:US
Mailing Address - Phone:817-292-7220
Mailing Address - Fax:817-332-6230
Practice Address - Street 1:5801 OAKBEND TRL
Practice Address - Street 2:SUITE 175
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3912
Practice Address - Country:US
Practice Address - Phone:817-292-7220
Practice Address - Fax:817-332-6230
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF61422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX354305ZHA9Medicare PIN
TXB27068Medicare UPIN
TX8826J0Medicare ID - Type Unspecified