Provider Demographics
NPI:1275548836
Name:KERKHOFF, THOMAS R (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:KERKHOFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:R
Other - Last Name:KERKHOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-338-0091
Mailing Address - Fax:352-338-0091
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-5491
Practice Address - Fax:352-265-5420
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5944103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R71190Medicare UPIN
FL68974ZMedicare PIN
FL68974WMedicare PIN
FL68974YMedicare PIN
FL68974Medicare ID - Type Unspecified