Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS6215 | FL |
NPI | 1215025457 |
---|---|
Provider Name | Brett Philip Thomas |
First Address | Belle Isle, FL 32812-2331 |
Second Address | Orlando, FL 32807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 31/05/2018 |