Provider Demographics
NPI:1922068782
Name:DONNER, THOMAS R (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:DONNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5478
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-5478
Mailing Address - Country:US
Mailing Address - Phone:985-447-2645
Mailing Address - Fax:985-447-2604
Practice Address - Street 1:604 N ACADIA RD
Practice Address - Street 2:SUITE 410
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4847
Practice Address - Country:US
Practice Address - Phone:985-447-2645
Practice Address - Fax:985-447-2604
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAL019872174400000X
LAMD.019872207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1394556Medicaid
LA5L163Medicare ID - Type Unspecified
LA1394556Medicaid
LAE27682Medicare UPIN