Provider Demographics
NPI:1033105176
Name:THOMAS, PHILIP K (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:K
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PHILIP
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4428 SUGARTREE DR E
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1861
Mailing Address - Country:US
Mailing Address - Phone:863-644-2704
Mailing Address - Fax:
Practice Address - Street 1:4428 SUGARTREE DR E
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1861
Practice Address - Country:US
Practice Address - Phone:863-644-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29153208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER
1497748743OtherGROUP NPI / LRHSI
FL272077900Medicaid
FL03530OtherBCBS OF FLORIDA
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER
FL272077900Medicaid