Provider Demographics
NPI:1912964024
Name:TRIEU, THOMAS T (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:T
Last Name:TRIEU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 DIVISION ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-2906
Mailing Address - Country:US
Mailing Address - Phone:228-374-2800
Mailing Address - Fax:228-374-2801
Practice Address - Street 1:1025 DIVISION ST
Practice Address - Street 2:SUITE B
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-2906
Practice Address - Country:US
Practice Address - Phone:228-374-2800
Practice Address - Fax:228-374-2801
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118789Medicaid
MS00118789Medicaid