Healthcare Provider Details

I. General information

NPI: 1477581387
Provider Name (Legal Business Name): THOMAS OPERCHAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 COPA D ORO
MARATHON FL
33050-2402
US

IV. Provider business mailing address

843 COPA D ORO
MARATHON FL
33050-2402
US

V. Phone/Fax

Practice location:
  • Phone: 305-743-9032
  • Fax: 305-743-9032
Mailing address:
  • Phone: 305-743-9032
  • Fax: 305-743-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME 40166
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: