Provider Demographics
NPI:1649216904
Name:MIMS, THOMAS H (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:MIMS
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 1:3525 PRYTANIA ST.
Mailing Address - Street 2:SUITE 526
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3585
Mailing Address - Country:US
Mailing Address - Phone:504-648-2510
Mailing Address - Fax:504-897-2064
Practice Address - Street 1:3525 PRYTANIA ST.
Practice Address - Street 2:SUITE 526
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3585
Practice Address - Country:US
Practice Address - Phone:504-648-2510
Practice Address - Fax:504-897-2064
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020638207RN0300X
LA20638207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1018180Medicaid
F43661Medicare UPIN
LA1018180Medicaid