Provider Demographics
NPI:1740394121
Name:CASANOVA, THOMAS HENRY III (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HENRY
Last Name:CASANOVA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70527-1022
Mailing Address - Country:US
Mailing Address - Phone:337-783-3073
Mailing Address - Fax:337-783-2548
Practice Address - Street 1:515 E 6TH ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-4503
Practice Address - Country:US
Practice Address - Phone:337-783-3073
Practice Address - Fax:337-783-2548
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05392R207W00000X, 207Y00000X, 2082S0099X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Not Answered2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1334979Medicaid
LA50468Medicare ID - Type Unspecified
LAB62418Medicare UPIN