Provider Demographics
NPI:1124019732
Name:SOILEAU, THOMAS Y (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:Y
Last Name:SOILEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:ATTN: JUDY
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-0250
Mailing Address - Country:US
Mailing Address - Phone:337-363-6480
Mailing Address - Fax:337-363-6492
Practice Address - Street 1:504 JACK MILLER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5600
Practice Address - Country:US
Practice Address - Phone:337-363-6480
Practice Address - Fax:337-363-6492
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD012341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1135054Medicaid
LA5K580Medicare ID - Type Unspecified
LA1135054Medicaid