Healthcare Provider Details

I. General information

NPI: 1053114678
Provider Name (Legal Business Name): DAVID EDWIN THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3545
US

IV. Provider business mailing address

8230 RIVERBIRCH DR
ROSWELL GA
30076-3545
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTRN42226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: