Provider Demographics
NPI:1629243431
Name:BERRY, THOMAS JOEL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOEL
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 1:64301 HIGHWAY 434
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-5411
Mailing Address - Country:US
Mailing Address - Phone:985-718-1274
Mailing Address - Fax:985-882-4501
Practice Address - Street 1:64301 HIGHWAY 434
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-5411
Practice Address - Country:US
Practice Address - Phone:985-718-1274
Practice Address - Fax:985-882-4501
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7072208VP0014X
LA207737208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
310591YQPXMedicare PIN