Basic Information
| Provider Information | |||||||||
| NPI: | 1710987268 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAINE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD FACC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 NORTH E STREET | ||||||||
| Address2: | SUITE 333 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504441717 | ||||||||
| FaxNumber: | 8508571747 | ||||||||
| Practice Location | |||||||||
| Address1: | 5151 N 9TH AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508571700 | ||||||||
| FaxNumber: | 8508571747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2005 | ||||||||
| LastUpdateDate: | 01/23/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME87460 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 2667185 00 | 05 | FL | MEDICAID | 009942915 | 05 | AL | MEDICAID |