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General NPI Number Information
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NPI Number | 1962698522
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Entity Type | Organization
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Legal Business Name | CORAL GABLES EXECUTIVE PHYSICIANS LLC
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 550 BILTMORE WAY SUITE 101
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City | CORAL GABLES
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State | FL
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Zip | 33134-5730
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Country | US
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Telephone | 305-446-9940
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Fax | 305-446-0861
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Provider Business Mailing Address
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Address Line | 550 BILTMORE WAY SUITE 101
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City | CORAL GABLES
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State | FL
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Zip | 33134-5730
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Country | US
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Telephone | 305-446-9940
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Fax | 305-446-0861
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT HENRY THOMAS
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Credential | MD
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Telephone | 305-446-9940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0063452
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License Number State | FL
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