Individual
DELORES THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
5311 GRAND BLVD, NEW PORT RICHEY, FL 34652-4014
(727) 848-3962
(727) 848-7028
Mailing address
5311 GRAND BLVD, NEW PORT RICHEY, FL 34652-4014
(727) 848-3962
(727) 848-7028
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT736
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102054
AVMED
—
01
—
1028829
AETNA
FL
01
—
162388
WELLCARE
FL
01
—
162388
HEALTHEASE
—
01
—
203026
AMERIGROUP
FL
01
—
29500
GHI
—
01
—
71416
VISTA
—
01
—
Y909A
BCBS
FL
Enumeration date
07/19/2006
Last updated
07/09/2007
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