Provider Demographics
NPI:1609892595
Name:WARD, THOMAS G (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:WARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:11373 CORTEZ BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5414
Mailing Address - Country:US
Mailing Address - Phone:352-597-2604
Mailing Address - Fax:352-596-0520
Practice Address - Street 1:11373 CORTEZ BLVD
Practice Address - Street 2:STE 400
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5414
Practice Address - Country:US
Practice Address - Phone:352-597-2604
Practice Address - Fax:352-596-0520
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS04712207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1609892595OtherMEDICRE INDIVIDUAL NPI
FL035201201Medicaid
FL1194714485OtherMEDICARE GROUP NPI
FL1194714485OtherMEDICARE GROUP NPI
FL80184WMedicare ID - Type Unspecified