Provider Demographics
NPI:1013969559
Name:MARCANTEL, THOMAS L (CRNA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:MARCANTEL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6000 BOCAGE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2191
Mailing Address - Country:US
Mailing Address - Phone:318-419-0756
Mailing Address - Fax:337-392-4982
Practice Address - Street 1:815 S 10TH STREET
Practice Address - Street 2:DOCTORS HOSPITAL
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446
Practice Address - Country:US
Practice Address - Phone:337-392-5088
Practice Address - Fax:337-392-4984
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAPO3911367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1104515Medicaid
LA1013969559OtherBCBS OF LA
LA4B916DP07Medicare PIN