Provider Demographics
NPI:1063421949
Name:THOMAS, ANNIE (MD)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3684 TAMPA ROAD
Mailing Address - Street 2:UNIT 3
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-6351
Mailing Address - Country:US
Mailing Address - Phone:813-818-4516
Mailing Address - Fax:813-855-2809
Practice Address - Street 1:3684 TAMPA ROAD
Practice Address - Street 2:UNIT 3
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-6351
Practice Address - Country:US
Practice Address - Phone:813-818-4516
Practice Address - Fax:813-855-2809
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D65371Medicare UPIN
62520Medicare ID - Type Unspecified