Organization
DEPARTMENT OF VETERANS AFFAIRS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VIRGINIA D. TOM PA-C (PHYSICIAN ASSISTANT)
(903) 583-6307
Entity
Organization
Contact information
Practice address
1201 E 9TH ST, BONHAM, TX 75418-4059
(903) 583-6307
(903) 583-6339
Mailing address
1201 E 9TH ST, BONHAM, TX 75418-4059
(903) 583-6307
(903) 583-6339
Taxonomy
Speciality
Code
Description
License number
State
261QV0200X
VA Clinic/Center
Primary
PA04043
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1031923
NCCPA
—
01
—
PA04043
TX STATE BOARD OF PA EXAM
TX
Enumeration date
05/09/2006
Last updated
08/08/2008
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