Provider Demographics
NPI:1154564235
Name:COYNE, THOMAS MAZUR (MD, PHD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MAZUR
Last Name:COYNE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100275
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0275
Mailing Address - Country:US
Mailing Address - Phone:352-273-7839
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-5618
Practice Address - Country:US
Practice Address - Phone:352-273-7839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115262207ZF0201X, 207ZN0500X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology