MEDICARE: DONALD WAYNE THOMAS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9111311	FL
2	363A00000X	Physician Assistant	PA0000001124	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699734095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD WAYNE THOMAS PA

Provider Business Mailing Address
First Line	:	602 SECOND ST
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-1604
Country	:	US
Telephone Number	:	615-351-5320
Fax Number	:

Provider Business Practice Location Address
First Line	:	11111 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2448
Country	:	US
Telephone Number	:	850-804-2900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	02/06/2023

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Directions to “ DONALD WAYNE THOMAS PA” Practice Location

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