Provider Demographics
NPI:1407843287
Name:VINSON, THOMAS CHILDRESS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHILDRESS
Last Name:VINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16010 PARK VALLEY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3574
Mailing Address - Country:US
Mailing Address - Phone:512-244-9944
Mailing Address - Fax:512-244-9977
Practice Address - Street 1:16010 PARK VALLEY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681
Practice Address - Country:US
Practice Address - Phone:512-244-9944
Practice Address - Fax:512-244-9977
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2018-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL20432086S0129X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX78GNOtherBCBS
TX8292N0Medicare PIN
TX00896MMedicare PIN
E51182Medicare UPIN