Provider Demographics
NPI:1548133986
Name:THOMAS, BRIAN TIMOTHY
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:TIMOTHY
Last Name:THOMAS
Suffix:
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 1:572 POCAHONTAS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3259
Mailing Address - Country:US
Mailing Address - Phone:850-774-8934
Mailing Address - Fax:
Practice Address - Street 1:572 POCAHONTAS DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-3259
Practice Address - Country:US
Practice Address - Phone:850-774-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)