| Entity Name: | THOMAS J. DERBES, M.D., L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 08 Mar 2016 (9 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | L16000053127 |
| FEI/EIN Number | 81-1867768 |
| Address: | 2202 STATE AVE, STE 108, Panama City, FL, 32405, US |
| Mail Address: | 2202 STATE AVE, STE 108, Panama City, FL, 32405, US |
| ZIP code: | 32405 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033573720 | 2016-04-08 | 2016-04-08 | 100 DOCTORS DR, SUITE B, PANAMA CITY, FL, 324057608, US | 100 DOCTORS DR, SUITE B, PANAMA CITY, FL, 324057608, US | |||||||||||||||||||||||||||
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| Phone | +1 850-872-1300 |
| Fax | 8508729420 |
| Fax | 8508721300 |
Authorized person
| Name | MRS. BRENDA BURNS |
| Role | ADM |
| Phone | 8508721300 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | ME48177 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 26046 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DERBES THOMAS JM.D. | Agent | 2202 STATE AVE, Panama City, FL, 32405 |
| Name | Role | Address |
|---|---|---|
| DERBES THOMAS JM.D. | Manager | 2202 STATE AVE, Panama City, FL, 32405 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-21 | 2202 STATE AVE, STE 108, Panama City, FL 32405 | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-21 | 2202 STATE AVE, STE 108, Panama City, FL 32405 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-21 | 2202 STATE AVE, STE 108, Panama City, FL 32405 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-04-21 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-02-18 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-27 |
| Florida Limited Liability | 2016-03-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
