Provider Demographics
NPI:1487926861
Name:THOMAS E. CARSON, MD, PA
Entity type:Organization
Organization Name:THOMAS E. CARSON, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-938-1908
Mailing Address - Street 1:1259 S PINELLAS AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3719
Mailing Address - Country:US
Mailing Address - Phone:727-938-1908
Mailing Address - Fax:727-938-8693
Practice Address - Street 1:4111 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1743
Practice Address - Country:US
Practice Address - Phone:727-938-1908
Practice Address - Fax:727-938-8693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9655207Q00000X
FLARNP3391502363L00000X
FLME36578207Q00000X
FLME110547207Q00000X
FLPA9105368363A00000X
FLARNP1658442363LF0000X
FLME108731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1043236565OtherNPI GROUP TARPON PRACTICE
FL1487926861OtherNPI GROUP NUMBER TRINITY
FL002575201Medicaid
FL1043236565OtherNPI GROUP TARPON PRACTICE