Van Diver, Thor William

Van Diver, Thor William is an individual health care provider with primary practice located at 701 6Th St S , St Petersburg FL 33701-4814. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Van Diver, Thor William can be contacted via phone (727) 823-2188.

Contact Information

Primary practice address
701 6Th St S St Petersburg FL 33701-4814
Phone: (727) 823-2188
Fax: (727) 828-0723
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X ME88143 Florida

Profile Details

NPI number 1023061934
LBN Legal business name Van Diver, Thor William
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 19th, 2006
Last updated Oct 5th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023061934 NPPES
Florida Other P00407541 RAILROAD MCR LINKED TO GRP# CF4811
Florida MEDICAID 268026200 RAILROAD MCR LINKED TO GRP# CF4811
Florida Other 81367 RAILROAD MCR LINKED TO GRP# CF4811

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