Provider Demographics
NPI:1093799611
Name:THOMAS, GARRY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:JOSEPH
Last Name:THOMAS
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 1:6233 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4022
Mailing Address - Country:US
Mailing Address - Phone:954-721-0000
Mailing Address - Fax:954-721-6308
Practice Address - Street 1:1901 S CONGRESS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6556
Practice Address - Country:US
Practice Address - Phone:561-602-7773
Practice Address - Fax:561-336-2267
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038774-E207W00000X
FLME91656207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1172681Medicaid
PATH109851Medicare ID - Type Unspecified
PAE53919Medicare UPIN