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General NPI Number Information
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NPI Number | 1780904508
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Entity Type | Organization
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Legal Business Name | THOMAS G BOUWKAMP MD PA
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 931 TOPPINO DR
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City | KEY WEST
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State | FL
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Zip | 33040-4269
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Country | US
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Telephone | 813-685-2191
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Fax | 813-689-8755
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Provider Business Mailing Address
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Address Line | 321 E ROBERTSON ST
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City | BRANDON
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State | FL
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Zip | 33511-5253
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Country | US
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Telephone | 813-685-2191
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Fax | 813-689-8755
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS G BOUWKAMP
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Credential | MD PA
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Telephone | 813-685-2191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME0046848
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License Number State | FL
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