Provider Demographics
NPI:1528038338
Name:PEELE, THOMAS C (MD07)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:PEELE
Suffix:
Gender:M
Credentials:MD07
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 THORNTON RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-6026
Mailing Address - Country:US
Mailing Address - Phone:850-878-3784
Mailing Address - Fax:
Practice Address - Street 1:2416 E PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5301
Practice Address - Country:US
Practice Address - Phone:850-877-7123
Practice Address - Fax:850-878-7036
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19495208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54559Medicare UPIN