MEDICARE: DR. THOMAS GARDNER FOREMAN MD

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	208600000X	Surgery Physician	130772	NY
2	208600000X	Surgery Physician	MD36329	SC
3	208600000X	Surgery Physician	21260	MS
4	208600000X	Surgery Physician	TD141049	ME
5	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	MD36329	SC

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	:	1942284047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS GARDNER FOREMAN MD

Provider Business Mailing Address
First Line	:	5220 BELFORT RD
Second Line	:	STE 130
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6017
Country	:	US
Telephone Number	:	904-446-3737
Fax Number	:	904-446-3013

Provider Business Practice Location Address
First Line	:	5050 HIGHWAY 17 BYP S
Second Line	:	SOUTH STRAND MEDICAL CENTER
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4500
Country	:	US
Telephone Number	:	843-839-6006
Fax Number	:

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	08/20/2015

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