Provider Demographics
NPI:1225023641
Name:SUNNENBERG, THOMAS D (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:SUNNENBERG
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 1:1545 AIRPORT BLVD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8615
Mailing Address - Country:US
Mailing Address - Phone:850-416-6933
Mailing Address - Fax:850-416-6934
Practice Address - Street 1:1545 AIRPORT BLVD
Practice Address - Street 2:SUITE 2000
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8615
Practice Address - Country:US
Practice Address - Phone:850-416-6933
Practice Address - Fax:850-416-6934
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0035969207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066486300Medicaid
FLD86211Medicare UPIN
FL68283YMedicare ID - Type Unspecified