Provider Demographics
NPI:1962482166
Name:BIRRIEL-SALCEDO, TOMAS (MD)
Entity Type:Individual
Prefix:
First Name:TOMAS
Middle Name:
Last Name:BIRRIEL-SALCEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TOMAS
Other - Middle Name:
Other - Last Name:BIRRIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3433
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70381-3433
Mailing Address - Country:US
Mailing Address - Phone:985-384-7173
Mailing Address - Fax:985-384-7057
Practice Address - Street 1:1151 MARGUERITE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1850
Practice Address - Country:US
Practice Address - Phone:985-384-7173
Practice Address - Fax:985-384-7057
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014614208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA17-00034OtherUNITED HEALTHCARE
LA1909581Medicaid
LA1909581Medicaid
LA17-00034OtherUNITED HEALTHCARE