Provider Demographics
NPI:1609094309
Name:BERRY, THOMAS CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHRISTOPHER
Last Name:BERRY
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 1:1990 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-7055
Mailing Address - Country:US
Mailing Address - Phone:985-868-9300
Mailing Address - Fax:985-851-0053
Practice Address - Street 1:1302 LAKEWOOD DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1889
Practice Address - Country:US
Practice Address - Phone:985-300-5438
Practice Address - Fax:985-380-1029
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202016208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1178608Medicaid
LA4N172Medicare PIN
LA1178608Medicaid