Provider Demographics
NPI:1740366376
Name:THOMAS, TERRIE R (MD)
Entity type:Individual
Prefix:DR
First Name:TERRIE
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUE DE LA VIE ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5126
Mailing Address - Country:US
Mailing Address - Phone:225-201-0505
Mailing Address - Fax:225-935-2190
Practice Address - Street 1:500 RUE DE LA VIE ST
Practice Address - Street 2:SUITE 310
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5126
Practice Address - Country:US
Practice Address - Phone:225-201-0505
Practice Address - Fax:225-935-2190
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026050174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1056359Medicaid