Provider Demographics
NPI:1801834940
Name:PRESBREY, THOMAS G (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:PRESBREY
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 1:8791 CONFERENCE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5822
Mailing Address - Country:US
Mailing Address - Phone:239-938-3506
Mailing Address - Fax:
Practice Address - Street 1:63 BARKLEY CIR
Practice Address - Street 2:STE. 100 & 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4514
Practice Address - Country:US
Practice Address - Phone:239-938-3500
Practice Address - Fax:239-278-0588
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00553652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLO36321900Medicaid
FLP00318898OtherRR MEDICARE FRL
FL09248OtherBCBS OF FLORIDA
FL09248NMedicare PIN
FL300126814Medicare ID - Type UnspecifiedRR -FL RAD CONSULTANTS
FLO36321900Medicaid
FL300064844Medicare PIN
FLP00318898OtherRR MEDICARE FRL
E95542Medicare UPIN