Basic Information
| Provider Information | |||||||||
| NPI: | 1225023641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUNNENBERG | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1545 AIRPORT BLVD | ||||||||
| Address2: | SUITE 2000 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504166933 | ||||||||
| FaxNumber: | 8504166934 | ||||||||
| Practice Location | |||||||||
| Address1: | 1545 AIRPORT BLVD | ||||||||
| Address2: | SUITE 2000 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504166933 | ||||||||
| FaxNumber: | 8504166934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 02/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 0035969 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 066486300 | 05 | FL | MEDICAID |