Provider Demographics
NPI:1811070790
Name:THOMAS, GRIFFITH MOSE (MD)
Entity type:Individual
Prefix:
First Name:GRIFFITH
Middle Name:MOSE
Last Name:THOMAS
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 1:1009 FALLS PKWY
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-4630
Mailing Address - Country:US
Mailing Address - Phone:830-637-7302
Mailing Address - Fax:
Practice Address - Street 1:1009 FALLS PKWY
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654
Practice Address - Country:US
Practice Address - Phone:830-637-7302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3847208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097984101Medicaid
TX00DF55Medicare ID - Type Unspecified
TXC22602Medicare UPIN