Provider Demographics
NPI:1033430871
Name:THOMAS A. TOMLIN M.D. PA
Entity Type:Organization
Organization Name:THOMAS A. TOMLIN M.D. PA
Other - Org Name:PONTE VEDRA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-285-9355
Mailing Address - Street 1:3948 3RD ST S # 384
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5847
Mailing Address - Country:US
Mailing Address - Phone:904-285-9355
Mailing Address - Fax:904-285-7442
Practice Address - Street 1:1100 SAWGRASS VILLAGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-5048
Practice Address - Country:US
Practice Address - Phone:904-285-9355
Practice Address - Fax:904-285-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty