Provider Demographics
NPI:1346250271
Name:THOMAS M MIXA MD PA
Entity Type:Organization
Organization Name:THOMAS M MIXA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MIXA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-321-9644
Mailing Address - Street 1:2410 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2236
Mailing Address - Country:US
Mailing Address - Phone:727-321-9644
Mailing Address - Fax:727-223-4157
Practice Address - Street 1:1609 PASADENA AVE S STE 1A
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4514
Practice Address - Country:US
Practice Address - Phone:727-321-9644
Practice Address - Fax:727-321-8580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067156207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376828700Medicaid
FLME0067156OtherLICENSE
FL376828700Medicaid
FL376828700Medicaid
FLME0067156OtherLICENSE