Healthcare Provider Details

I. General information

NPI: 1457341307
Provider Name (Legal Business Name): THOMAS D RINEY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4553 WATKINS ST
PACE FL
32571-2511
US

IV. Provider business mailing address

335 ANDREW JACKSON TRL
GULF BREEZE FL
32561-4412
US

V. Phone/Fax

Practice location:
  • Phone: 850-800-2772
  • Fax: 850-994-4080
Mailing address:
  • Phone: 850-512-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberME0060612
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number60612
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME60612
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME0060612
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME60612
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberME0060612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: