Basic Information
Provider Information
NPI: 1033191176
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEBERARDINO
FirstName: THOMAS
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8300 FLOYD CURL DR FL 3
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782293931
CountryCode: US
TelephoneNumber: 2104509300
FaxNumber: 2104506023
Practice Location
Address1: 8300 FLOYD CURL DR FL 3
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782293931
CountryCode: US
TelephoneNumber: 2104509300
FaxNumber: 2104506023
Other Information
ProviderEnumerationDate: 11/15/2005
LastUpdateDate: 01/27/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/27/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XQ9597TXN Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 
207XX0005XQ9597TXY Allopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine

ID Information
IDTypeStateIssuerDescription
103319117605CT MEDICAID
103319117605TX MEDICAID


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