Healthcare Provider Details

I. General information

NPI: 1497457923
Provider Name (Legal Business Name): PATRICK MENDEL THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CENTERVILLE RD STE 107
TALLAHASSEE FL
32308-4638
US

IV. Provider business mailing address

1401 CENTERVILLE RD STE 107
TALLAHASSEE FL
32308-4638
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-5567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTRN37529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: