Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Thomas Waller, MD

Individual provider Family Medicine Physician · NPI 1629066857

Thomas Waller, MD is a Family Practice in Jacksonville, Florida. Graduated from Mercer University School of Medicine in 1996, 30 years ago. Practices with Mayo Clinic Jacksonville, a 1,581-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Florida.

Years since qualifying
30
Trained at
Mercer University School of Medicine
Licensed in
FL
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone: (904) 953-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence ME74184 (FL)

Record details

NPI number1629066857
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedOctober 11, 2005
Last updated in NPPESAugust 28, 2020
Certification dateAugust 28, 2020
Mailing address4500 San Pablo Rd S, Jacksonville, FL 32224-1865

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolMERCER UNIVERSITY SCHOOL OF MEDICINE
Graduated 1996 (30 years in practice)
Group practice Mayo Clinic Jacksonville — 1581 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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