Provider Demographics
NPI:1568450625
Name:DERBES, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:DERBES
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 1:2202 STATE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4539
Mailing Address - Country:US
Mailing Address - Phone:850-872-1300
Mailing Address - Fax:850-872-1300
Practice Address - Street 1:2202 STATE AVE
Practice Address - Street 2:STE 101
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4539
Practice Address - Country:US
Practice Address - Phone:850-872-1300
Practice Address - Fax:850-872-1300
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48177208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26046OtherBLUE CROSS BLUE SHIELD
FL042840000Medicaid
FL042840000Medicaid
FLD53437Medicare UPIN