Provider Demographics
NPI:1558420976
Name:THOMAS, LARRY D (MD FICS FACS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD FICS FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880
Mailing Address - Country:US
Mailing Address - Phone:863-299-5424
Mailing Address - Fax:863-299-8455
Practice Address - Street 1:575 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880
Practice Address - Country:US
Practice Address - Phone:863-299-5414
Practice Address - Fax:863-299-2732
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036360208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
D50806Medicare UPIN
03720Medicare ID - Type Unspecified