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General NPI Number Information
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NPI Number | 1457642761
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Entity Type | Individual
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Provider Name | BRIAN THOMAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 341 N MAITLAND AVE STE 210
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City | MAITLAND
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State | FL
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Zip | 32751-4771
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Country | US
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Telephone | 407-641-5178
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Fax | 586-580-4446
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Provider Business Mailing Address
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Address Line | PO BOX 160968
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32716-0968
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Country | US
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Telephone |
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Fax | 586-580-4446
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME130883
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License Number State | FL
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