Provider Demographics
NPI:1528213394
Name:THOMAS, JOHN BEASLEY IV (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BEASLEY
Last Name:THOMAS
Suffix:IV
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 1:2202 STATE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7601
Mailing Address - Country:US
Mailing Address - Phone:850-640-3320
Mailing Address - Fax:
Practice Address - Street 1:2202 STATE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7601
Practice Address - Country:US
Practice Address - Phone:850-640-3320
Practice Address - Fax:850-640-2569
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102627207PE0004X, 207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine