Provider Demographics
NPI:1962817445
Name:VENGALOOR THOMAS, TOMS (MD)
Entity type:Individual
Prefix:
First Name:TOMS
Middle Name:
Last Name:VENGALOOR THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TOMS
Other - Middle Name:
Other - Last Name:V THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:408 EMERALD TRL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 W WOODROW WILSON AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7681
Practice Address - Country:US
Practice Address - Phone:601-984-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230102792085R0001X
MS276712085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology