Provider Demographics
NPI:1841416633
Name:THOMAS, GLORIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SEMINOLE DR
Mailing Address - Street 2:#1457
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3232
Mailing Address - Country:US
Mailing Address - Phone:513-490-8149
Mailing Address - Fax:
Practice Address - Street 1:NEW IMAGE COSMETIC SURGERY
Practice Address - Street 2:1350 ORLANDO AVE
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-774-8001
Practice Address - Fax:407-389-0825
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME876782086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00614052OtherRAILROAD MEDICARE