Healthcare Provider Details

I. General information

NPI: 1710419213
Provider Name (Legal Business Name): THOMAS DAVID JOSEPH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 N MAGNOLIA AVE
ORLANDO FL
32803-3809
US

IV. Provider business mailing address

736 N MAGNOLIA AVE
ORLANDO FL
32803-3809
US

V. Phone/Fax

Practice location:
  • Phone: 407-423-7149
  • Fax:
Mailing address:
  • Phone: 407-423-7149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME149230
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: