Individual
THOMAS JACOB SEALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1034 MAR WALT DR UNIT 100, FORT WALTON BEACH, FL 32547-6637
(850) 863-2153
Mailing address
PO BOX 740923, ATLANTA, GA 30374-0923
(850) 863-2153
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
131396
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02171200
—
FL
01
—
14092927
CAQH
FL
01
—
ON9E7
BCBS
FL
Enumeration date
04/30/2012
Last updated
01/28/2021
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