Healthcare Provider Details

I. General information

NPI: 1548271596
Provider Name (Legal Business Name): NEIL ALLEN THIERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12512 BRUCE B DOWNS BLVD
TAMPA FL
33612-9209
US

IV. Provider business mailing address

6913 COHASSET CIR
RIVERVIEW FL
33578-8314
US

V. Phone/Fax

Practice location:
  • Phone: 813-977-8700
  • Fax: 813-971-2029
Mailing address:
  • Phone: 813-731-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number91604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: