Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 0S013305 | PA |
N | 208800000X | Urologist | 2603 | WV |
Y | 208800000X | Urologist | OS10348 | FL |
NPI | 1043416506 |
---|---|
Provider Name | Shawn Wayne Thomas |
First Address | Orlando, FL 32886-4074 |
Second Address | Daytona Beach, FL 32114-2757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 27/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000282900 | (05) | FL |
3810024050 | (05) | WV |