Provider Demographics
NPI:1326381369
Name:SPACKMAN, THOMAS JAMES (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:SPACKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:JAMES
Other - Last Name:SPACKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:351 WESTWIND CT
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963
Mailing Address - Country:US
Mailing Address - Phone:772-388-4631
Mailing Address - Fax:
Practice Address - Street 1:351 WESTWIND CT
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963
Practice Address - Country:US
Practice Address - Phone:772-589-2409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0125432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology