Provider Demographics
NPI:1972642668
Name:MORAN, THOMAS W (PA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:W
Last Name:MORAN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2492 S CITIES SERVICE HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70665-6497
Mailing Address - Country:US
Mailing Address - Phone:337-905-1962
Mailing Address - Fax:337-905-1063
Practice Address - Street 1:2492 S CITIES SERVICE HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70665-6497
Practice Address - Country:US
Practice Address - Phone:337-905-1962
Practice Address - Fax:337-905-1063
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2024-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085-001820363A00000X
LA200545363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant