Provider Demographics
NPI:1063828101
Name:HUNTER, THOMAS BRONSON (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BRONSON
Last Name:HUNTER
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 1:713 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4553
Mailing Address - Country:US
Mailing Address - Phone:407-421-8303
Mailing Address - Fax:
Practice Address - Street 1:1230 VIA SALERNO
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2601
Practice Address - Country:US
Practice Address - Phone:407-645-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52214208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery