Provider Demographics
NPI:1427073907
Name:TOMLIN, THOMAS ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALLEN
Last Name:TOMLIN
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 1:830 A1A N STE 13-137
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3287
Mailing Address - Country:US
Mailing Address - Phone:904-608-1420
Mailing Address - Fax:
Practice Address - Street 1:830 A1A N STE 13-137
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3287
Practice Address - Country:US
Practice Address - Phone:904-608-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592452553OtherCHAMPUS
FL79818XOtherBLUE CROSS BLUE SHIELD
FL068247100Medicaid
FL080060491OtherRAILROAD MEDICARE
FL79818Medicare ID - Type Unspecified
FL592452553OtherCHAMPUS