Provider Demographics
NPI:1568676690
Name:THURMAN, ANTHONY RAY
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:RAY
Last Name:THURMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 MADELINE ST
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-2514
Mailing Address - Country:US
Mailing Address - Phone:318-728-3600
Mailing Address - Fax:
Practice Address - Street 1:424 MADELINE ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-2514
Practice Address - Country:US
Practice Address - Phone:318-728-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5685250001Medicare ID - Type Unspecified