Provider Demographics
NPI:1730161548
Name:ANDERSON, THOMAS N (D O)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:N
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3040 N WICKHAM RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2369
Mailing Address - Country:US
Mailing Address - Phone:321-428-4840
Mailing Address - Fax:321-428-4841
Practice Address - Street 1:3040 N WICKHAM RD
Practice Address - Street 2:SUITE 10
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2369
Practice Address - Country:US
Practice Address - Phone:321-428-4840
Practice Address - Fax:321-428-4841
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5950ZMedicare UPIN