Provider Demographics
NPI:1396902813
Name:KLEIN, THOMAS JACOB (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JACOB
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Mailing Address - Street 1:1860 BOY SCOUT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2119
Mailing Address - Country:US
Mailing Address - Phone:239-215-1180
Mailing Address - Fax:239-215-1179
Practice Address - Street 1:7850 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2114
Practice Address - Country:US
Practice Address - Phone:754-205-0099
Practice Address - Fax:954-388-5849
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1168392085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13400OtherDIMENSIONS HEALTH
FL29497OtherMEDICA
FL905338OtherWELLCARE
FLF00364377301OtherUNITED HEALTHCARE
FLNA530OtherMEDICARE
FLP514785Medicaid
FL009122300Medicaid
FL13400OtherDIMENSION HEALTH
FLP1009831OtherFREEDOM HEALTH
FLP01208989OtherRAILROAD MCR
FL3069343OtherCIGNA
FLP0016965OtherFLORIDA HEALTHCARE PLUS
FLP949278OtherOPTIMUM
FLQMP000003701324OtherMOLINA HEALTHCARE
FL366734OtherAVMED
FL14R13OtherBCBS OF FL
FL3069343OtherCIGNA