Healthcare Provider Details

I. General information

NPI: 1841416633
Provider Name (Legal Business Name): GLORIA J THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NEW IMAGE COSMETIC SURGERY 1350 ORLANDO AVE
WINTER PARK FL
32789
US

IV. Provider business mailing address

1040 SEMINOLE DR #1457
FORT LAUDERDALE FL
33304-3232
US

V. Phone/Fax

Practice location:
  • Phone: 407-774-8001
  • Fax: 407-389-0825
Mailing address:
  • Phone: 513-490-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME87678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: