Provider Demographics
NPI:1942284047
Name:FOREMAN, THOMAS GARDNER (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GARDNER
Last Name:FOREMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5220 BELFORT RD
Mailing Address - Street 2:STE 130
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6017
Mailing Address - Country:US
Mailing Address - Phone:904-446-3737
Mailing Address - Fax:904-446-3013
Practice Address - Street 1:5050 HIGHWAY 17 BYP S
Practice Address - Street 2:SOUTH STRAND MEDICAL CENTER
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4500
Practice Address - Country:US
Practice Address - Phone:843-839-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130772208600000X
SCMD36329208600000X, 2083P0011X
MS21260208600000X
METD141049208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0648635Medicaid
MS302I024764Medicare PIN
MS0648635Medicaid