Provider Demographics
NPI:1053692921
Name:SIMON, THOMAS CLARK JR (ATP,CRTS)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CLARK
Last Name:SIMON
Suffix:JR
Gender:M
Credentials:ATP,CRTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 W MOCKINGBIRD LN
Mailing Address - Street 2:#101
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5630
Mailing Address - Country:US
Mailing Address - Phone:214-951-9710
Mailing Address - Fax:214-951-9720
Practice Address - Street 1:2601 W MOCKINGBIRD LN
Practice Address - Street 2:#101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5630
Practice Address - Country:US
Practice Address - Phone:214-951-9710
Practice Address - Fax:214-951-9720
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXATP4344247200000X
TX1008601247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other