Healthcare Provider Details

I. General information

NPI: 1033420898
Provider Name (Legal Business Name): THOMAS GREGORY KUERBITZ II PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2010
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14027 5TH ST
DADE CITY FL
33525-4302
US

IV. Provider business mailing address

403 E 11TH ST
PANAMA CITY FL
32401-3409
US

V. Phone/Fax

Practice location:
  • Phone: 352-518-2000
  • Fax:
Mailing address:
  • Phone: 850-767-3350
  • Fax: 850-767-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2725
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085003761
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: