Individual
DR. THOMAS ARTHUR GONWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
ME86183
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262864300
—
FL
01
—
390007795
RAILROAD MEDICARE
FL
01
—
58818
BLUECROSS/BLUESHIELD
FL
Enumeration date
10/17/2005
Last updated
09/30/2020
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