Individual
DR. THOMAS BLANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1110 BROAD AVE, SUITE 700, GULFPORT, MS 39501-8907
(228) 864-0314
(228) 864-0425
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 865-1453
(228) 865-1451
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
08702
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112507
—
MS
01
—
P00651241
RAILROAD MEDICARE
MS
Enumeration date
06/08/2006
Last updated
07/10/2014
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