Provider Demographics
NPI:1912114760
Name:THAI, THU (MD)
Entity type:Individual
Prefix:DR
First Name:THU
Middle Name:
Last Name:THAI
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 1:4064 MCLAUGHLIN DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2759
Mailing Address - Country:US
Mailing Address - Phone:850-894-6616
Mailing Address - Fax:
Practice Address - Street 1:4064 MCLAUGHLIN DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-2759
Practice Address - Country:US
Practice Address - Phone:850-894-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 431662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26608CMedicare ID - Type UnspecifiedTHU V THAI MD
FLF84336Medicare UPIN