Provider Demographics
NPI:1558723577
Name:THOMAS, JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:THOMAS
Suffix:
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 1:298 S YONGE ST
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-6264
Mailing Address - Country:US
Mailing Address - Phone:386-274-7800
Mailing Address - Fax:833-549-5578
Practice Address - Street 1:298 S YONGE STRET
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6264
Practice Address - Country:US
Practice Address - Phone:386-274-7800
Practice Address - Fax:833-549-5578
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88933207P00000X
AL38457207Q00000X
FLME147527207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZERHSOtherBCBS
ALO1993685Medicaid
FL108527000Medicaid