Provider Demographics
NPI:1922209139
Name:THOMAS, MOLLY BOYD (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:BOYD
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:LEIGH
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1211 COOLIDGE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2636
Mailing Address - Country:US
Mailing Address - Phone:337-289-8400
Mailing Address - Fax:337-289-8401
Practice Address - Street 1:1211 COOLIDGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2636
Practice Address - Country:US
Practice Address - Phone:337-289-8400
Practice Address - Fax:337-289-8401
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200913207R00000X
LAMD.200913207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR176811001Medicaid
LA1092789Medicaid
LA09278Medicaid
TX203958801Medicaid
LA4N577Medicare PIN
LA315221YUJDMedicare PIN
LA09278Medicaid
LA1092789Medicaid