Provider Demographics
NPI:1922195213
Name:THOMAS, BLAINE (MD)
Entity Type:Individual
Prefix:
First Name:BLAINE
Middle Name:
Last Name:THOMAS
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 1:2644 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:STE 121
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2248
Mailing Address - Country:US
Mailing Address - Phone:225-293-2523
Mailing Address - Fax:225-293-1807
Practice Address - Street 1:8212 KELWOOD AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4801
Practice Address - Country:US
Practice Address - Phone:225-929-7600
Practice Address - Fax:225-930-7524
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10076R207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1693316Medicaid
LA721435817TOtherHUMANA PROVIDER NUMBER
LAG44006OtherSTERLING PROVIDER NUMBER
LA050071038OtherRR MEDICARE PROVIDER NUMB
LA5Y302Medicare ID - Type UnspecifiedMEDICARE IND NUMBER
LA721435817TOtherHUMANA PROVIDER NUMBER