Provider Demographics
NPI:1285678805
Name:WILLINGHAM, THOMAS ALBERT III (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALBERT
Last Name:WILLINGHAM
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 512139
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-2139
Mailing Address - Country:US
Mailing Address - Phone:941-625-5895
Mailing Address - Fax:941-625-1047
Practice Address - Street 1:4161 TAMIAMI TRL STE 304D
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9254
Practice Address - Country:US
Practice Address - Phone:941-625-5895
Practice Address - Fax:941-625-1047
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME00764792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1216704OtherAETNA
FL138134OtherVALUE OPTIONS
FL1962626OtherFIRST HEALTH
FL23784OtherBCBS
FL3108154OtherGHI
FL611036400OtherDEPARTMENT OF LABOR
FL240681000OtherMAGELLAN
FL107738OtherUHC
FLP2860549OtherOXFORD HEALTH
FL240681000OtherMAGELLAN
FL23784AMedicare ID - Type Unspecified