Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD054141L | PA |
NPI | 1114009297 |
---|---|
Provider Name | Dr. Thomas L Spray |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 12/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001490327 | (05) | PA |
F90086 | (02) | PA |