Provider Demographics
NPI:1386731594
Name:THOMAS W. OWNBY JR. M.D. P.A.
Entity type:Organization
Organization Name:THOMAS W. OWNBY JR. M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WOODARD
Authorized Official - Last Name:OWNBY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:386-427-5218
Mailing Address - Street 1:510 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7325
Mailing Address - Country:US
Mailing Address - Phone:386-427-5218
Mailing Address - Fax:
Practice Address - Street 1:510 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7325
Practice Address - Country:US
Practice Address - Phone:386-427-5218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57644Medicare UPIN