Basic Information
| Provider Information | |||||||||
| NPI: | 1841339090 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHEW | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 SE 18TH AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344718213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527514885 | ||||||||
| FaxNumber: | 3527515371 | ||||||||
| Practice Location | |||||||||
| Address1: | 17345 SE 109TH TERRACE RD | ||||||||
| Address2: | |||||||||
| City: | SUMMERFIELD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344918930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527514885 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-112670 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | ME104719 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.