Healthcare Provider Details

I. General information

NPI: 1780904508
Provider Name (Legal Business Name): THOMAS G BOUWKAMP MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 TOPPINO DR
KEY WEST FL
33040-4269
US

IV. Provider business mailing address

321 E ROBERTSON ST
BRANDON FL
33511-5253
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-2191
  • Fax: 813-689-8755
Mailing address:
  • Phone: 813-685-2191
  • Fax: 813-689-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME0046848
License Number StateFL

VIII. Authorized Official

Name: DR. THOMAS G BOUWKAMP
Title or Position: PRESIDENT
Credential: MD PA
Phone: 813-685-2191