Provider Demographics
NPI:1679558357
Name:THOMLEY, MARTIN L (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:L
Last Name:THOMLEY
Suffix:
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 1:109 MILLSAPS DR
Mailing Address - Street 2:STE B
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1587
Mailing Address - Country:US
Mailing Address - Phone:601-255-0736
Mailing Address - Fax:601-255-0735
Practice Address - Street 1:109 MILLSAPS DR STE B
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1587
Practice Address - Country:US
Practice Address - Phone:601-255-0736
Practice Address - Fax:601-255-0735
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17963207W00000X
MS28079207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529403900Medicaid
ALF55089OtherHEALTH SPRING
AL0800277OtherUNITED HEALTH CARE
AL05713OtherBLUE CROSS
AL051505713Medicare ID - Type Unspecified
AL0800277OtherUNITED HEALTH CARE