Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | ME 108980 | FL |
NPI | 1538369228 |
---|---|
Provider Name | Dr. Damita L. Thomas |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Fort Myers, FL 33916-2216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 07/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003929900 | (05) | FL |