Healthcare Provider Details

I. General information

NPI: 1366422784
Provider Name (Legal Business Name): THOMAS VERNON MESSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 WOODBINE RD
PACE FL
32571-8790
US

IV. Provider business mailing address

PO BOX 402063
ATLANTA GA
30384-2063
US

V. Phone/Fax

Practice location:
  • Phone: 850-994-6575
  • Fax: 850-994-5643
Mailing address:
  • Phone: 850-994-6575
  • Fax: 850-994-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME94364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: