Provider Demographics
NPI:1184654055
Name:SERIO, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SERIO
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 1:1802 MICCOSUKEE COMMONS DRIVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-656-5411
Mailing Address - Fax:850-878-5486
Practice Address - Street 1:1802 MICCOSUKEE COMMONS DRIVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5432
Practice Address - Country:US
Practice Address - Phone:850-656-5411
Practice Address - Fax:850-878-5486
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377627100Medicaid
FL26855XMedicare ID - Type Unspecified
FL40629KMedicare PIN
FLG01844Medicare UPIN