Provider Demographics
NPI:1427195957
Name:THOMAS, CHARRELL (MD)
Entity Type:Individual
Prefix:
First Name:CHARRELL
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7651 GATE PKWY
Mailing Address - Street 2:APARTMENT 2104
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2896
Mailing Address - Country:US
Mailing Address - Phone:904-858-1574
Mailing Address - Fax:904-398-4263
Practice Address - Street 1:3900 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4313
Practice Address - Country:US
Practice Address - Phone:904-858-1574
Practice Address - Fax:904-398-4263
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80036207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3541142Medicare ID - Type Unspecified
FLH24031Medicare UPIN