Provider Demographics
NPI:1770511669
Name:GULICK, THOMAS ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:GULICK
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 1:312 GRAMMONT STREET;
Mailing Address - Street 2:SUITE 402
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-966-6550
Mailing Address - Fax:318-966-6551
Practice Address - Street 1:312 GRAMMONT STREET;
Practice Address - Street 2:SUITE 402
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-966-6550
Practice Address - Fax:318-966-6551
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0141192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154275001Medicaid
LA1326968Medicaid
AR154275001Medicaid
LA5J1307843Medicare ID - Type Unspecified