Provider Demographics
NPI:1366412355
Name:ZOELLER, THOMAS LEIGH (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEIGH
Last Name:ZOELLER
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 1:2760 SE 17TH STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5550
Mailing Address - Country:US
Mailing Address - Phone:352-629-0028
Mailing Address - Fax:352-629-1512
Practice Address - Street 1:2760 SE 17TH STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5550
Practice Address - Country:US
Practice Address - Phone:352-629-0028
Practice Address - Fax:352-629-1512
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 45155208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D58310Medicare UPIN
FL73284Medicare ID - Type Unspecified