Provider Demographics
NPI:1992816466
Name:MOLINA, THOMAS J (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:MOLINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TOMAS
Other - Middle Name:JAIME
Other - Last Name:MOLINA-ESCOBAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3820 HIGHWAY 365 STE 400
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-7565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3820 HIGHWAY 365 STE 400
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7565
Practice Address - Country:US
Practice Address - Phone:409-727-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6528207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D2519Medicare ID - Type UnspecifiedBEAUMONT
TX8F0849Medicare ID - Type Unspecified
TXE66395Medicare UPIN