Provider Demographics
NPI:1427005081
Name:ODMARK, THOMAS E (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:ODMARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:430 MORTON PLANT ST
Mailing Address - Street 2:STE 301
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3395
Mailing Address - Country:US
Mailing Address - Phone:727-461-6026
Mailing Address - Fax:727-461-7446
Practice Address - Street 1:12416 66TH STREET N
Practice Address - Street 2:SUITE A
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-3437
Practice Address - Country:US
Practice Address - Phone:727-547-4700
Practice Address - Fax:727-394-8661
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME95245207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00302879OtherRAILROAD MEDICARE
FLP00302879OtherRAILROAD MEDICARE
FL41048ZMedicare PIN