Provider Demographics
NPI:1508869934
Name:THOMAS, IGNATIUS (MD)
Entity Type:Individual
Prefix:DR
First Name:IGNATIUS
Middle Name:
Last Name:THOMAS
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 1:1051 GAUSE BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2951
Mailing Address - Country:US
Mailing Address - Phone:985-726-2655
Mailing Address - Fax:985-643-9808
Practice Address - Street 1:1051 GAUSE BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2951
Practice Address - Country:US
Practice Address - Phone:985-726-2655
Practice Address - Fax:985-643-9808
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14027207RC0000X
MS11618207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00017357Medicaid
LA188649128DOtherBLUE CROSS BLUE SHIELD
LA1173690Medicaid
060018916OtherRAILROAD MEDICARE
LA188649128DOtherBLUE CROSS BLUE SHIELD
060018916OtherRAILROAD MEDICARE
LA1173690Medicaid