Provider Demographics
NPI:1871775767
Name:THOMAS A GUEST PHD PA
Entity type:Organization
Organization Name:THOMAS A GUEST PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUEST
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-682-6330
Mailing Address - Street 1:108 W CITRUS ST
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2502
Mailing Address - Country:US
Mailing Address - Phone:407-682-6330
Mailing Address - Fax:407-682-5972
Practice Address - Street 1:108 W CITRUS ST
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2502
Practice Address - Country:US
Practice Address - Phone:407-682-6330
Practice Address - Fax:407-682-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0002866103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S18734Medicare UPIN
74331Medicare PIN