Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | ME127999 | FL |
NPI | 1629395843 |
---|---|
Provider Name | Dr. Matthew Wayne Thomas |
First Address | St Petersburg, FL 33701-4804 |
Second Address | St Petersburg, FL 33701-4804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2010 |
Last Update Date | 22/11/2021 |