Healthcare Provider Details

I. General information

NPI: 1447254479
Provider Name (Legal Business Name): THOMAS FRANCIS BLISS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUTLER DR
PROVIDENCE RI
02906-4862
US

IV. Provider business mailing address

PO BOX 1119
PROVIDENCE RI
02901-1119
US

V. Phone/Fax

Practice location:
  • Phone: 401-330-1455
  • Fax: 401-330-1456
Mailing address:
  • Phone: 401-330-1455
  • Fax: 401-330-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberRI4203
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number04203
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: