Provider Demographics
NPI:1154362176
Name:HUBER, THOMAS S (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:HUBER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:STUART
Other - Last Name:HUBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-273-5484
Mailing Address - Fax:352-273-5515
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-5484
Practice Address - Fax:352-273-5515
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME677532086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375766800Medicaid
FL375766800Medicaid
FL68720ZMedicare PIN