Healthcare Provider Details

I. General information

NPI: 1487063608
Provider Name (Legal Business Name): THOMAS E. CARSON,MD,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 S PINELLAS AVE
TARPON SPRINGS FL
34689-3719
US

IV. Provider business mailing address

1259 S PINELLAS AVE
TARPON SPRINGS FL
34689-3719
US

V. Phone/Fax

Practice location:
  • Phone: 727-938-1908
  • Fax: 727-938-8693
Mailing address:
  • Phone: 727-938-1908
  • Fax: 727-938-8693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number10D0681094
License Number StateFL

VIII. Authorized Official

Name: THOMAS CARSON
Title or Position: PRESIDENT/PHYSICIAN
Credential: MD
Phone: 727-938-1908