Provider Demographics
NPI:1740375005
Name:THOMAS, DANIEL R (DO, MS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 CANADICE LANE
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5520
Mailing Address - Country:US
Mailing Address - Phone:407-602-8516
Mailing Address - Fax:
Practice Address - Street 1:344 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-5702
Practice Address - Country:US
Practice Address - Phone:352-729-0923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7406208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN
OTH000Medicare UPIN