Provider Demographics
NPI:1467422048
Name:WILLIAMS, THOMAS ST CLAIR SR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ST CLAIR
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13430
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71213-3430
Mailing Address - Country:US
Mailing Address - Phone:318-343-6487
Mailing Address - Fax:318-343-7884
Practice Address - Street 1:516 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-4252
Practice Address - Country:US
Practice Address - Phone:318-343-6487
Practice Address - Fax:318-343-7884
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022964207Q00000X
LAMD022964207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1685895Medicaid
LA5A130Medicare PIN
G64048Medicare UPIN
LA1685895Medicaid