Provider Demographics
NPI:1124454079
Name:THOMAS, DONALD C III (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:C
Last Name:THOMAS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DONALD
Other - Middle Name:CUBERY
Other - Last Name:THOMAS
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1839 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8900
Mailing Address - Country:US
Mailing Address - Phone:727-322-1054
Mailing Address - Fax:727-821-7213
Practice Address - Street 1:8133 54TH AVE N.
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1001
Practice Address - Country:US
Practice Address - Phone:727-541-4458
Practice Address - Fax:727-546-6663
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117477207R00000X, 207R00000X
CAC50058207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4HA2OtherBCBS
FL120143300Medicaid