Provider Demographics
NPI:1720113533
Name:LUNDY, THOMAS MARK (PA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MARK
Last Name:LUNDY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 40767
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-0767
Mailing Address - Country:US
Mailing Address - Phone:904-376-3707
Mailing Address - Fax:904-391-5807
Practice Address - Street 1:9090 REGENCY SQUARE BLVD
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-8119
Practice Address - Country:US
Practice Address - Phone:904-724-5576
Practice Address - Fax:904-724-0721
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2015-02-02
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Provider Licenses
StateLicense IDTaxonomies
FLPA2439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant