Provider Demographics
NPI:1205879459
Name:EDWARDS, THOMAS LLOYD (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LLOYD
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:L
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-0537
Mailing Address - Country:US
Mailing Address - Phone:352-206-4165
Mailing Address - Fax:888-523-3008
Practice Address - Street 1:12844 JOE HARIG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:FL
Practice Address - Zip Code:33576-0537
Practice Address - Country:US
Practice Address - Phone:352-206-4165
Practice Address - Fax:888-523-3008
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-0006349207Q00000X
FLOS6349207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370860800Medicaid
FL56339OtherAOA NUMBER
FLOS-0006349OtherOSTEOPATHIC LICENSE
FLOS-0006349OtherOSTEOPATHIC LICENSE
FLBE3211733OtherDEA REGISTRATION NUMBER
FL370860800Medicaid