THOMAS E DIVER (NPI# 1215057278) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215057278 |
| Entity Type | Individual |
| Full Name | THOMAS E DIVER |
| Credential | PA |
| Practice Address |
855 Montgomery Fort Worth TX 76107-2553 |
| Mailing Address |
Po Box 99335 Fort Worth TX 76199-0335 |
| Practice Telephone | 8177352228 |
| Practice Fax Number | 8177352582 |
| Mailing Telephone | 8177352228 |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2010-06-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | PA01931 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA01931 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BCBS | 8Y8828 | 01 |
| TX | RAILROAD MEDICARE | P00824014 | 01 |
| TX | 197025301 | 05 |
| Street Address |
855 MONTGOMERY |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76107-2553 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194711747 | Victor Lamont Holmes | Physician Assistant | 855 Montgomery, Fort Worth, TX 76107-2553 | 2005-09-20 |
| 1093117848 | Keely Nicole Grant Mirle | Nurse Practitioner | 855 Montgomery, Fort Worth, TX 76107-2553 | 2014-09-24 |
| 1750722187 | Felicia Ann Hoffman | Physician Assistant | 855 Montgomery, Fort Worth, TX 76107-2553 | 2013-07-15 |
| 1194075101 | Christie Peer Shanafelt | Neuromusculoskeletal Medicine & OMM | 855 Montgomery, Fort Worth, TX 76107-2553 | 2012-09-17 |
| 1760737142 | Tomi Omolara Ola-peters | Internal Medicine | 855 Montgomery, Fort Worth, TX 76107-2553 | 2012-07-20 |
| 1386930709 | Crystal Diane Walker | Physician Assistant | 855 Montgomery, Fort Worth, TX 76107-2553 | 2011-06-23 |
| 1881908598 | America E Mcguffee | Physician Assistant | 855 Montgomery, Fort Worth, TX 76107-2553 | 2010-08-05 |
| 1144534173 | James Raymond Leddy | Physician Assistant | 855 Montgomery, Fort Worth, TX 76107-2553 | 2010-08-02 |
| 1548401094 | Yue-qing Tan | Internal Medicine | 855 Montgomery, Fort Worth, TX 76107-2553 | 2009-03-13 |
| 1386892966 | Anjali Kumar | Family Medicine | 855 Montgomery, Fort Worth, TX 76107-2553 | 2008-09-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629683602 | Renovo Wound and Hyperbarics Pllc | Emergency Medicine | 5668 Edwards Ranch Road, Suite 101, Fort Worth, TX 76107 | 2020-09-15 |
| 1669085437 | Ryan Bourgeois | Nurse Practitioner | 2917 Crocket Street, Fort Worth, TX 76107 | 2020-08-31 |
| 1053920546 | Christa Marie Widjaja | Optometrist | 1700 Montgomery St, Fort Worth, TX 76107 | 2020-07-30 |
| 1093351355 | Raymond Iannone | Pharmacist | 850 Montgomery St, Suite #310, Fort Worth, TX 76107 | 2019-11-21 |
| 1053963744 | Cumulus Injury Resolution, Inc. | Chiropractor | 4936 Byers Avenue, Fort Worth, TX 76107 | 2019-07-12 |
| 1770135576 | Shadia Osakwe | Physician Assistant | 855 Montgomery Street, Pediatric Clinic, Fort Worth, TX 76107 | 2019-07-11 |
| 1568945442 | Sachin P Patel | Physical Therapist | 4825 Wellesley St, Fort Worth, TX 76107 | 2018-09-07 |
| 1023594025 | Ftw Pharmacy Services Inc | Durable Medical Equipment & Medical Supplies | 2912 W 6th St Ste 150, Fort Worth, TX 76107 | 2018-07-13 |
| 1669974325 | Helen Williamson Elliott | Counselor | 1751 River Run #217, Fort Worth, TX 76107 | 2018-03-08 |
| 1487156931 | Pelvic Neuromonitoring Pllc | Electrodiagnostic Medicine | 111 Boland St #211, Ft Worth, TX 76107 | 2018-03-01 |
| Find all providers in zip 76107 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598314742 | Tan Ngo | Physician Assistant | 3025 N Tarrant Pkwy Ste 140, Fort Worth, TX 76177-8625 | 2019-09-10 |
| 1699321240 | Hannah Bram | Physician Assistant | 1400 8th Ave Fl 1, Fort Worth, TX 76104-4110 | 2019-08-09 |
| 1942654462 | Damon A Cates | Physician Assistant | Fmc Carswell, J St Bldg 3000, Fort Worth, TX 76127 | 2016-04-21 |
| 1790159721 | Victoria Constant | Physician Assistant | 3701 Vision Dr Ste 101, Fort Worth, TX 76109-1184 | 2015-11-13 |
| 1962828871 | Erika Zuniga Martinez | Physician Assistant | 800 7th Ave, Fort Worth, TX 76104-2704 | 2014-03-16 |
| 1336562883 | Elizabeth Suzanne Widmer | Physician Assistant | 12469 Timberland Blvd Ste 501, Fort Worth, TX 76244-5216 | 2014-02-03 |
| 1225475536 | Female Health Associates of North Texas, LLC | Physician Assistant | 1327 Hemphill St, Suit 100, Fort Worth, TX 76104-4735 | 2013-05-28 |
| 1427255330 | Alhaji Mahama Mumuni | Physician Assistant | 3305 Miller Ave Ste B, Fort Worth, TX 76119-1956 | 2007-07-03 |
| 1427144518 | Glenda Rose Hagman | Physician Assistant | 1400 S Main St Ste 406, Fort Worth, TX 76104-4913 | 2006-10-05 |
| 1073533725 | Michael Howard Johnson | Physician Assistant | 4504 Boat Club Rd Ste 800, Fort Worth, TX 76135-7002 | 2006-07-19 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76107 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.