Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | ME0013329 | FL |
NPI | 1073555728 |
---|---|
Provider Name | Dr. Thomas I Lawhorn JR. |
First Address | Tallahassee, FL 32308-5321 |
Second Address | Tallahassee, FL 32308-5321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E14925 | (02) | FL |