Provider Demographics
NPI:1548448475
Name:THOMAS, DESMOND (MD)
Entity type:Individual
Prefix:
First Name:DESMOND
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2979 PGA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2911
Mailing Address - Country:US
Mailing Address - Phone:561-275-7604
Mailing Address - Fax:561-802-5385
Practice Address - Street 1:927 45TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2450
Practice Address - Country:US
Practice Address - Phone:561-841-0911
Practice Address - Fax:561-881-9959
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME100688207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280730100Medicaid
FLAK873ZMedicare PIN