| Doctor Name: | DR. THOMAS B SULISTIO |
| NPI Number: | 1851378079 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | G4408 |
| Business Practice Address: | 1000 Memorial Dr ` Denison, TX - 750202035 |
| Business Phone Number: | 9034164000 |
| Business Fax Number: | 9033278023 |
| Mailing Address: | 1302 N State Highway 91, DENISON |
| State: | TX |
| Postal Code: | 750201167 |
| Phone Number: | 9034651857 |
| Fax Number: | 9033278023 |
| NPI Enumeration Date: | 12/29/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | G4408 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |