Provider Demographics
NPI:1447254479
Name:BLISS, THOMAS FRANCIS JR (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:FRANCIS
Last Name:BLISS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1119
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02901-1119
Mailing Address - Country:US
Mailing Address - Phone:401-330-1455
Mailing Address - Fax:401-330-1456
Practice Address - Street 1:100 BUTLER DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4862
Practice Address - Country:US
Practice Address - Phone:401-330-1455
Practice Address - Fax:401-330-1456
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI4203207XX0005X
RI04203207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN7002079/ES00776Medicaid
IN209000177Medicare ID - Type Unspecified
IN007002079Medicare ID - Type Unspecified
IN7002079/ES00776Medicaid
RI007002079Medicare PIN