Provider Demographics
NPI:1508949611
Name:THOMMI, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:THOMMI
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 550698
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-0698
Mailing Address - Country:US
Mailing Address - Phone:904-733-6677
Mailing Address - Fax:904-733-0081
Practice Address - Street 1:2061 HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3815
Practice Address - Country:US
Practice Address - Phone:904-786-7331
Practice Address - Fax:904-786-4034
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME45964OtherFL STATE LICENSE #
FL043093500Medicaid
FLME45964OtherFL STATE LICENSE #
FL043093500Medicaid