Provider Information for 1972847119
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Mr. DAVID MALCOM THOMAS
Sex: Male
NPI: 1972847119
Last Updated: 2012-11-10
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1972847119 | ||||||||
| Enumeration Date | 2012-11-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 5925 IMPERIAL PKWY SUITE 128 MULBERRY, FL 33860-8476 United States Phone: 863-214-8653 | Fax:863-937-9210 | ||||||||
| Primary Practice Address | 5925 IMPERIAL PKWY SUITE 128 MULBERRY, FL 33860-8476 United States Phone: 863-214-8653 | Fax:863-937-9210 | ||||||||
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