Provider Demographics
NPI:1952301699
Name:CARPENTER, THOMAS J (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 BRYAN DAIRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1353
Mailing Address - Country:US
Mailing Address - Phone:727-544-2500
Mailing Address - Fax:727-541-6165
Practice Address - Street 1:8250 BRYAN DAIRY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1353
Practice Address - Country:US
Practice Address - Phone:727-544-2500
Practice Address - Fax:727-541-6165
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32833207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002056700Medicaid
MN134M1CAOtherBCBS
MN075297500Medicaid
E39856Medicare UPIN
FL002056700Medicaid
FLE39856Medicare UPIN
FL80557KMedicare PIN