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General NPI Number Information
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NPI Number | 1356309611
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Entity Type | Individual
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Provider Name | THOMAS MIXA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 1609 PASADENA AVE S STE 1A
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-4514
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Country | US
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Telephone | 727-321-9644
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Fax | 727-321-8580
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Provider Business Mailing Address
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Address Line | 2410 NORTHSIDE DR
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City | CLEARWATER
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State | FL
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Zip | 33761-2236
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Country | US
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Telephone | 727-499-0351
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Fax | 727-223-4159
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME0067156
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License Number State | FL
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