Provider Demographics
NPI:1821575986
Name:THOGMARTIN, JON R
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:R
Last Name:THOGMARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 ULMERTON RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-1633
Mailing Address - Country:US
Mailing Address - Phone:727-582-6800
Mailing Address - Fax:
Practice Address - Street 1:10900 ULMERTON RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-1633
Practice Address - Country:US
Practice Address - Phone:727-582-6800
Practice Address - Fax:727-582-6844
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71056207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology