Provider Demographics
NPI:1578714135
Name:THOMAS, ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
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 1:1012 LUCERNE TER
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1015
Mailing Address - Country:US
Mailing Address - Phone:401-423-1039
Mailing Address - Fax:407-425-2347
Practice Address - Street 1:1012 LUCERNE TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1015
Practice Address - Country:US
Practice Address - Phone:401-423-1039
Practice Address - Fax:407-425-2347
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106204207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006677200Medicaid
FLME106204OtherMEDICAL LICENSE
FLGQ384ZMedicare PIN