Provider Demographics
NPI:1992777916
Name:CARSON, THOMAS PHILIP (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:PHILIP
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 1:3813 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6264
Mailing Address - Country:US
Mailing Address - Phone:407-902-2866
Mailing Address - Fax:407-902-2867
Practice Address - Street 1:3813 OAKWATER CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6264
Practice Address - Country:US
Practice Address - Phone:407-902-2866
Practice Address - Fax:407-902-2867
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043895174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47680YMedicare ID - Type Unspecified
FLD55140Medicare UPIN