Provider Demographics
NPI:1013920362
Name:THOMAS, CORWIN ASHFORD (DO)
Entity Type:Individual
Prefix:DR
First Name:CORWIN
Middle Name:ASHFORD
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 E FARREL RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7208
Mailing Address - Country:US
Mailing Address - Phone:337-234-3163
Mailing Address - Fax:337-234-3168
Practice Address - Street 1:802 E FARREL RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7208
Practice Address - Country:US
Practice Address - Phone:337-234-3163
Practice Address - Fax:337-234-3168
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14733R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1129453Medicaid
LADE4750OtherRAILROAD MEDICARE
LADE4750OtherRAILROAD MEDICARE
LAH71289Medicare UPIN