Provider Demographics
NPI:1093714859
Name:THOMAS, CLINTON LAVURN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:LAVURN
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:985 ROBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2063
Mailing Address - Country:US
Mailing Address - Phone:985-641-8643
Mailing Address - Fax:985-645-9856
Practice Address - Street 1:405 CHRISTIAN LN
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1356
Practice Address - Country:US
Practice Address - Phone:985-643-6579
Practice Address - Fax:985-645-9856
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA06426R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist