Provider Demographics
NPI:1538489778
Name:THOMAS, RICHARD STANLEY
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:STANLEY
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2699 LEE RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1753
Mailing Address - Country:US
Mailing Address - Phone:407-896-9500
Mailing Address - Fax:407-896-9585
Practice Address - Street 1:2699 LEE RD
Practice Address - Street 2:SUITE 510
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1753
Practice Address - Country:US
Practice Address - Phone:407-896-9500
Practice Address - Fax:407-896-9585
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA1352367500000X
FLANT9234759367500000X
TN22353367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ195150Medicare PIN