Provider Demographics
NPI:1780904508
Name:THOMAS G BOUWKAMP MD PA
Entity type:Organization
Organization Name:THOMAS G BOUWKAMP MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOUWKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:813-685-2191
Mailing Address - Street 1:321 E ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5253
Mailing Address - Country:US
Mailing Address - Phone:813-685-2191
Mailing Address - Fax:813-689-8755
Practice Address - Street 1:931 TOPPINO DR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4269
Practice Address - Country:US
Practice Address - Phone:813-685-2191
Practice Address - Fax:813-689-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046848207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty