Provider Demographics
NPI:1588786859
Name:TOM ELLER, II, MD, PA
Entity type:Organization
Organization Name:TOM ELLER, II, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:254-624-7071
Mailing Address - Street 1:4314 PAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-8654
Mailing Address - Country:US
Mailing Address - Phone:254-624-7071
Mailing Address - Fax:214-619-5222
Practice Address - Street 1:4401 COIT RD
Practice Address - Street 2:STE 313
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0500
Practice Address - Country:US
Practice Address - Phone:254-624-7071
Practice Address - Fax:214-619-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y025Medicare PIN