Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN20589 | FL |
NPI | 1063825990 |
---|---|
Provider Name | Dr. Thomas Ryan Mcpherson |
First Address | Gulf Breeze, FL 32561-4380 |
Second Address | Gulf Breeze, FL 32561 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2014 |
Last Update Date | 27/07/2018 |