Individual
THOMAS R FANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1120 STATE RD 436, SUITE 1400, CASSELBERRY, FL 32707
(407) 671-8010
(407) 671-4155
Mailing address
1120 STATE RD 436, SUITE 1400, CASSELBERRY, FL 32707
(407) 671-8010
(407) 671-4155
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO0001035
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041060800
—
FL
Enumeration date
08/24/2006
Last updated
11/08/2010
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