Healthcare Provider Details

I. General information

NPI: 1003300732
Provider Name (Legal Business Name): JONATHAN DAVID THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2018
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number276511
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME178692
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number178692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: