Provider Demographics
NPI:1184944068
Name:GREENE, THOMAS HARVEY III (PA-C)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:HARVEY
Last Name:GREENE
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32341-0173
Mailing Address - Country:US
Mailing Address - Phone:850-973-9980
Mailing Address - Fax:850-973-9988
Practice Address - Street 1:248 NE HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2560
Practice Address - Country:US
Practice Address - Phone:850-973-9980
Practice Address - Fax:850-973-9988
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2014-07-03
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical