Healthcare Provider Details

I. General information

NPI: 1093774606
Provider Name (Legal Business Name): THOMAS EADS HEBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10423 OLD HAMMOND HWY
BATON ROUGE LA
70816-8264
US

IV. Provider business mailing address

10423 OLD HAMMOND HWY
BATON ROUGE LA
70816-8264
US

V. Phone/Fax

Practice location:
  • Phone: 225-923-0960
  • Fax: 225-923-3736
Mailing address:
  • Phone: 225-923-0960
  • Fax: 225-923-3736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD011004
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: