Provider Demographics
NPI:1427058791
Name:CARSON, THOMAS E (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:CARSON
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 1:1259 S PINELLAS AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3719
Mailing Address - Country:US
Mailing Address - Phone:727-938-1908
Mailing Address - Fax:727-938-8693
Practice Address - Street 1:1259 S PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3719
Practice Address - Country:US
Practice Address - Phone:727-938-1908
Practice Address - Fax:727-938-8693
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039716400Medicaid
FL1427058791OtherNPI
FL1043236565OtherGROUP NPI
FL1427058791OtherNPI
FL039716400Medicaid
FL62270ZMedicare PIN