Provider Demographics
NPI:1417944257
Name:PACE, THOMAS ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANTHONY
Last Name:PACE
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 1:985 9TH AVE SW
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-4500
Mailing Address - Country:US
Mailing Address - Phone:205-481-7373
Mailing Address - Fax:205-481-7375
Practice Address - Street 1:985 9TH AVE SW
Practice Address - Street 2:SUITE 309
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4500
Practice Address - Country:US
Practice Address - Phone:205-481-7373
Practice Address - Fax:205-481-7375
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000083001Medicaid
AL000083001Medicaid
83001Medicare ID - Type Unspecified