Provider Demographics
NPI:1396716775
Name:WESTBROOK, THOMAS G (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:WESTBROOK
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 1:6160 N DAVIS HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6994
Mailing Address - Country:US
Mailing Address - Phone:850-473-1121
Mailing Address - Fax:850-473-1122
Practice Address - Street 1:6160 N DAVIS HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6994
Practice Address - Country:US
Practice Address - Phone:850-473-1121
Practice Address - Fax:850-473-1122
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50944207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59151445OtherBCBS OF ALABAMA
FL41528OtherBCBS OF FLORIDA
FLZ460OtherHEALTH FIRST NETWORK
FL266719300Medicaid
FLZ460OtherHEALTH FIRST NETWORK
FLK1311Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
FL99001227Medicare ID - Type UnspecifiedRAILROAD MEDICARE