Healthcare Provider Details

I. General information

NPI: 1679674303
Provider Name (Legal Business Name): THOMAS BYRON THAMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3364 WINDY WOOD DR
ORLANDO FL
32812-6047
US

IV. Provider business mailing address

3364 WINDY WOOD DR
ORLANDO FL
32812-6047
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-8058
  • Fax: 407-273-5146
Mailing address:
  • Phone: 407-277-8058
  • Fax: 407-273-5146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberME 6906
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: