Individual
THOR WILLIAM VAN DIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME88143
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268026200
—
FL
01
—
81367
BCBS FL
FL
01
—
P00407541
RAILROAD MCR LINKED TO GRP# CF4811
FL
Enumeration date
05/19/2006
Last updated
10/05/2010
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