Provider Demographics
NPI:1821046376
Name:ULRICH, THOMAS W (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:ULRICH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:884 SW BROMELIA TER
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7144
Mailing Address - Country:US
Mailing Address - Phone:561-758-5473
Mailing Address - Fax:561-659-7846
Practice Address - Street 1:884 SW BROMELIA TER
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7144
Practice Address - Country:US
Practice Address - Phone:561-758-5473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101550363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P25917Medicare UPIN
E6075XMedicare ID - Type Unspecified