Individual
AJAY THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04515
TX
363AS0400X
Surgical Physician Assistant
PA04515
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
216179601
—
TX
05
—
216179610
—
TX
01
—
216179611
MEDICAID-CSHCN
TX
01
—
8LZ651
BCBS
TX
01
—
P00861336
RAILROAD MEDICARE
TX
Enumeration date
11/03/2005
Last updated
01/16/2020
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