Provider Demographics
NPI:1841269453
Name:CAREY, THOMAS DREW (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DREW
Last Name:CAREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E VAUGHN AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5951
Mailing Address - Country:US
Mailing Address - Phone:318-513-9400
Mailing Address - Fax:
Practice Address - Street 1:410 E VAUGHN AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5951
Practice Address - Country:US
Practice Address - Phone:318-513-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12187207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1150771Medicaid
LA50176Medicare ID - Type Unspecified
LA1150771Medicaid