Provider Demographics
NPI:1447509518
Name:FRETCH, THOMAS JOHN IV
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOHN
Last Name:FRETCH
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 S MIAMI AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1617
Mailing Address - Country:US
Mailing Address - Phone:305-374-6006
Mailing Address - Fax:305-789-4499
Practice Address - Street 1:155 S MIAMI AVE
Practice Address - Street 2:STE 400
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1617
Practice Address - Country:US
Practice Address - Phone:305-374-6006
Practice Address - Fax:305-789-4499
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker