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General NPI Number Information
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NPI Number | 1285938290
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Entity Type | Organization
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Legal Business Name | C. THOMMEN THOMAS, M.D., P.A.
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 165 W ROBERTSON ST
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City | BRANDON
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State | FL
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Zip | 33511-5111
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Country | US
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Telephone | 813-685-9693
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Fax | 813-685-9774
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Provider Business Mailing Address
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Address Line | 165 W ROBERTSON ST
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City | BRANDON
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State | FL
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Zip | 33511-5111
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Country | US
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Telephone | 813-685-9693
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Fax | 813-685-9774
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHEMPAKANALLORE THOMMEN THOMAS
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Credential | M.D.
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Telephone | 813-685-9693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME0042260
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License Number State | FL
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