Thomas R Fann, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

PO0001035 Issued in FL

Practice address

1120 State Rd 436
Suite 1400
Casselberry, FL 32707

Phone

(407) 671-8010

Fax

(407) 671-4155

NPI assigned

Aug 24, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Park Place Surgery Center L L C

  • Multi-Specialty Clinic/Center
  • Maitland, FL
  • NPI 1306866173
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289174400000",
    "number": "1396852364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 STATE RD 436",
            "address_2": "SUITE 1400",
            "city": "CASSELBERRY",
            "state": "FL",
            "postal_code": "32707",
            "telephone_number": "407-671-8010",
            "fax_number": "407-671-4155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 STATE RD 436",
            "address_2": "SUITE 1400",
            "city": "CASSELBERRY",
            "state": "FL",
            "postal_code": "32707",
            "telephone_number": "407-671-8010",
            "fax_number": "407-671-4155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANN",
        "first_name": "THOMAS",
        "middle_name": "R",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2010-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "FL",
            "license": "PO0001035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "041060800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in Casselberry, FL
• Providers in Casselberry, FL by specialty
• Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.