Provider Demographics
NPI:1114137114
Name:THOMAS J DERBES MD PA
Entity Type:Organization
Organization Name:THOMAS J DERBES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DERBES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-913-8996
Mailing Address - Street 1:2103 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4511
Mailing Address - Country:US
Mailing Address - Phone:850-913-8996
Mailing Address - Fax:850-913-8956
Practice Address - Street 1:2103 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4511
Practice Address - Country:US
Practice Address - Phone:850-913-8996
Practice Address - Fax:850-913-8956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48177208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26046OtherBLUE CROSS BLUE SHIELD
FL042840000Medicaid
FL042840000Medicaid
FLD53437Medicare UPIN