Provider Demographics
NPI:1053380493
Name:ALLEN, THOMAS J (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:ALLEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:P.O. BOX 5720
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32247-5720
Mailing Address - Country:US
Mailing Address - Phone:302-651-5985
Mailing Address - Fax:407-650-7578
Practice Address - Street 1:1717 S. ORANGE AVE. SUITE 100
Practice Address - Street 2:NEMOURS CHILDRENS CLINIC ORLANDO
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2946
Practice Address - Country:US
Practice Address - Phone:407-650-7715
Practice Address - Fax:407-650-7124
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-03-16
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Provider Licenses
StateLicense IDTaxonomies
VA01010578452080P0208X
MO20040170862080P0208X
FLME1102422080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases