Provider Demographics
NPI:1720069511
Name:MCNEILL, THOMAS M JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:MCNEILL
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:PO BOX 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:700 CENTRAL AVE STE 400
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3600
Practice Address - Country:US
Practice Address - Phone:727-895-1300
Practice Address - Fax:727-823-3494
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64913207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF96175Medicare UPIN
FL26503XMedicare ID - Type Unspecified