Provider Demographics
NPI:1811913437
Name:PRINCE, THOMAS ROY (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROY
Last Name:PRINCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:832 W CENTRAL BLVD
Mailing Address - Street 2:DEPARTMENT OF HEALTH, WOMENS SERVICES
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-1809
Mailing Address - Country:US
Mailing Address - Phone:407-858-1400
Mailing Address - Fax:407-858-5999
Practice Address - Street 1:6101 LAKE ELLENOR DR
Practice Address - Street 2:DEPARTMENT OF HEALTH, WOMENS SERVICES
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4616
Practice Address - Country:US
Practice Address - Phone:407-858-1400
Practice Address - Fax:407-858-5999
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME64430207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267386000Medicaid
FL267386000Medicaid
FLIB494ZMedicare PIN
FL2673860-00Medicaid