Provider Demographics
NPI:1720076862
Name:LORD-TOMAS, ANNE M (DO)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:M
Last Name:LORD-TOMAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13300-56 S. CLEVELAND AVE
Mailing Address - Street 2:#318
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:239-243-8222
Mailing Address - Fax:239-236-1595
Practice Address - Street 1:13300-56 S. CLEVELAND AVE
Practice Address - Street 2:#318
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907
Practice Address - Country:US
Practice Address - Phone:239-243-8222
Practice Address - Fax:239-236-1595
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9883207V00000X
TXL0386207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031359501Medicaid
FL276173400Medicaid
TX8A3660OtherBCBS
FL55034OtherBCBS OF FLORIDA
TX8A3660OtherBCBS
TXH22996Medicare UPIN
FL55034OtherBCBS OF FLORIDA
FLH22996Medicare ID - Type Unspecified
FLU8346XMedicare UPIN