Healthcare Provider Details

I. General information

NPI: 1356309611
Provider Name (Legal Business Name): THOMAS MIXA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 PASADENA AVE S STE 1A
SOUTH PASADENA FL
33707-4514
US

IV. Provider business mailing address

2410 NORTHSIDE DR
CLEARWATER FL
33761-2236
US

V. Phone/Fax

Practice location:
  • Phone: 727-321-9644
  • Fax: 727-321-8580
Mailing address:
  • Phone: 727-499-0351
  • Fax: 727-223-4159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0067156
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: