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General NPI Number Information
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NPI Number | 1285844902
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Entity Type | Individual
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Provider Name | THOMAS JAMES FOTOPOULOS D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8446 GARDENS CIR 9
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City | SARASOTA
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State | FL
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Zip | 34243-3066
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Country | US
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Telephone | 941-773-4508
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Fax |
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Provider Business Mailing Address
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Address Line | 8446 GARDENS CIR 9
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City | SARASOTA
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State | FL
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Zip | 34243-3066
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Country | US
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Telephone | 941-773-4508
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | OS 8476
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License Number State | FL
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