Provider Demographics
NPI:1891135125
Name:THOMAS, LIJA L (MD)
Entity type:Individual
Prefix:
First Name:LIJA
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:2340 E TRINITY MILLS RD STE 250
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1946
Mailing Address - Country:US
Mailing Address - Phone:972-417-8937
Mailing Address - Fax:
Practice Address - Street 1:1604 LANCASTER DR
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3544
Practice Address - Country:US
Practice Address - Phone:855-893-5637
Practice Address - Fax:817-666-3873
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD191023207Q00000X
LA303932207Q00000X
MS889-L207Q00000X
TXS4065207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05784011Medicaid
WI100088706Medicaid
TXP0246294OtherMEDICARE RAIL ROAD
LA2433504Medicaid
TX410493701Medicaid
TX8MK865OtherBCBS
TX1A1371OtherMEDICARE