Provider Demographics
NPI:1497840052
Name:BOOS, THOMAS ARCHER (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ARCHER
Last Name:BOOS
Suffix:
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 1:120 MEADOWCREST STREET
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5282
Mailing Address - Country:US
Mailing Address - Phone:504-391-7660
Mailing Address - Fax:504-393-2407
Practice Address - Street 1:120 MEADOWCREST STREET
Practice Address - Street 2:SUITE 450
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5282
Practice Address - Country:US
Practice Address - Phone:504-391-7660
Practice Address - Fax:504-393-2407
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014708208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB62513Medicare UPIN