Provider Demographics
NPI:1518971175
Name:THOMAN, CHARLES A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:THOMAN
Suffix:JR
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 1:3231 SW 34TH AVE
Mailing Address - Street 2:P.O. BOX 4860
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-8489
Mailing Address - Country:US
Mailing Address - Phone:352-873-7400
Mailing Address - Fax:352-873-7435
Practice Address - Street 1:3231 SW 34TH AVE.
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34478-4860
Practice Address - Country:US
Practice Address - Phone:352-873-7400
Practice Address - Fax:352-873-7435
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0011360208800000X
FLME113602086H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative Medicine
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048346000Medicaid
FL05260OtherUNSPECIFIED
FL048346000Medicaid
FLD51210Medicare UPIN