Provider Information for 1285879361
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Dr. THOMAS WILLIAM CLYBURN III PH.D.
Sex: Male
NPI: 1285879361
Last Updated: 2012-12-13
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1285879361 | ||||||||
| Enumeration Date | 2008-12-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4501 MANATEE AVE W # 209 BRADENTON, FL 34209-3952 United States Phone: 941-224-3800 | Fax:941-745-1630 | ||||||||
| Primary Practice Address | 318 OLD MAIN ST SUITE 21 BRADENTON, FL 34205-7819 United States Phone: 941-224-3800 | Fax:941-745-1630 | ||||||||
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