Provider Demographics
NPI:1316929516
Name:TRUNNELL, THOMAS NEWTON (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:NEWTON
Last Name:TRUNNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 BRUCE B DOWNS BLVD
Mailing Address - Street 2:#306
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3946
Mailing Address - Country:US
Mailing Address - Phone:813-977-1024
Mailing Address - Fax:813-632-0109
Practice Address - Street 1:13801 BRUCE B DOWNS BLVD
Practice Address - Street 2:#306
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3946
Practice Address - Country:US
Practice Address - Phone:813-977-1024
Practice Address - Fax:813-632-0109
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47750000207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D86277Medicare UPIN
FL78054ZMedicare PIN