Provider Demographics
NPI:1083674766
Name:THOMAS, HUGH WESLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:WESLEY
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 LAKE UNDERHILL RD STE 215
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4511
Mailing Address - Country:US
Mailing Address - Phone:321-235-0692
Mailing Address - Fax:321-235-0694
Practice Address - Street 1:12301 LAKE UNDERHILL RD STE 215
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4511
Practice Address - Country:US
Practice Address - Phone:321-235-0692
Practice Address - Fax:321-235-0694
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062351200Medicaid
FLP00960454OtherRAILROAD MEDICARE
FLOS0006004OtherLICENSE
FL080148275OtherPALMETTO GBA
FL80182XMedicare PIN
FLOS0006004OtherLICENSE
FL080148275OtherPALMETTO GBA
FL062351200Medicaid