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General NPI Number Information
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NPI Number | 1649457482
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Entity Type | Organization
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Legal Business Name | THOMAS WEIGHT LOSS MANAGEMENT SYSTEM, LLC
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | 12015 WHITMARSH LN
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City | TAMPA
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State | FL
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Zip | 33626-1737
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Country | US
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Telephone | 813-597-0202
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Fax | 813-425-9043
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Provider Business Mailing Address
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Address Line | 12015 WHITMARSH LN
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City | TAMPA
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State | FL
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Zip | 33626-1737
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Country | US
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Telephone | 813-597-0202
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Fax | 813-425-9043
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. STANLEY M THOMAS
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Credential | M.D.
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Telephone | 813-597-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME82489
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ME82489
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License Number State | FL
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