Provider Demographics
NPI:1720052384
Name:ENOCH, TOMMY ERRICE (MD)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:ERRICE
Last Name:ENOCH
Suffix:
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 1:1616 RIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5316
Mailing Address - Country:US
Mailing Address - Phone:850-656-8944
Mailing Address - Fax:850-878-1824
Practice Address - Street 1:1616 RIGGINS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5316
Practice Address - Country:US
Practice Address - Phone:850-656-8944
Practice Address - Fax:850-878-1824
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78078OtherBLUE CROSS BLUE SHIELD
D58357Medicare UPIN
78078ZMedicare PIN