Provider Demographics
NPI:1457341307
Name:RINEY, THOMAS D JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:RINEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 ANDREW JACKSON TRL
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4412
Mailing Address - Country:US
Mailing Address - Phone:850-512-4397
Mailing Address - Fax:
Practice Address - Street 1:4553 WATKINS ST
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-2511
Practice Address - Country:US
Practice Address - Phone:850-800-2772
Practice Address - Fax:850-994-4080
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060612207QA0401X, 2080P0204X, 207RA0401X
FL60612207RA0401X
FLME60612208000000X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5498188OtherAETNA
FLA259OtherHEALTH FIRST NETWORK
FL055110400Medicaid
AL59170194OtherBLUE CROSS BLUE SHIELD
FL12761OtherBLUE CROSS BLUE SHIELD
FL055110400Medicaid