Provider Demographics
NPI:1467682104
Name:THOMAS, GREYSON CLARKE (MD)
Entity Type:Individual
Prefix:DR
First Name:GREYSON
Middle Name:CLARKE
Last Name:THOMAS
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:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:FORT MC COY
Mailing Address - State:FL
Mailing Address - Zip Code:32134-0479
Mailing Address - Country:US
Mailing Address - Phone:352-236-2525
Mailing Address - Fax:352-236-8610
Practice Address - Street 1:15035 NE HWY 315
Practice Address - Street 2:
Practice Address - City:FORT MC COY
Practice Address - State:FL
Practice Address - Zip Code:32134
Practice Address - Country:US
Practice Address - Phone:352-236-2525
Practice Address - Fax:352-236-8610
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-2251207R00000X
FLME113591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine