Provider Demographics
NPI:1477581387
Name:OPERCHAL, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:OPERCHAL
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 1:843 COPA D ORO
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2402
Mailing Address - Country:US
Mailing Address - Phone:305-743-9032
Mailing Address - Fax:305-743-9032
Practice Address - Street 1:843 COPA D ORO
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2402
Practice Address - Country:US
Practice Address - Phone:305-743-9032
Practice Address - Fax:305-743-9032
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 40166174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44175Medicare ID - Type Unspecified
FLD54901Medicare UPIN