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Contact Information

THOMAS R FANN, DPM
1120 STATE RD 436
SUITE 1400
CASSELBERRY, FL32707
 Phone: 407-671-8010
 Fax: 407-671-4155
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for THOMAS R FANN · (Male)

NPI # 1396852364
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 08/24/2006
Last updated 11/08/2010 - About 16 years ago
Sole proprietor 1 No
Identifiers
  • FL License # PO0001035
  • FL Medicaid 041060800
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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