Provider Demographics
NPI:1699778332
Name:CONDER, THOMAS C (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:CONDER
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 1:1010 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230-3120
Mailing Address - Country:US
Mailing Address - Phone:940-872-1121
Mailing Address - Fax:940-872-3007
Practice Address - Street 1:1010 N MILL ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-3120
Practice Address - Country:US
Practice Address - Phone:940-872-1121
Practice Address - Fax:940-872-3007
Is Sole Proprietor?:No
Enumeration Date:2005-05-25
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000174336208600000X
TXM5671207P00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H44092Medicare UPIN