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General NPI Number Information
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NPI Number | 1114948387
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Entity Type | Organization
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Legal Business Name | THOMAS C. CHURCH M.D., PA
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 04/12/2010
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Provider Practice Location Address
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Address Line | 51 YACHT CLUB DR NE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4473
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Country | US
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Telephone | 850-244-1157
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Fax |
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Provider Business Mailing Address
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Address Line | 51 YACHT CLUB DR NE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4473
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Country | US
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Telephone | 850-244-1157
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | THOMAS CHURCH
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Credential |
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Telephone | 850-244-1157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME0016848
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License Number State | FL
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