Healthcare Provider Details

I. General information

NPI: 1740394121
Provider Name (Legal Business Name): THOMAS HENRY CASANOVA III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E 6TH ST
CROWLEY LA
70526-4503
US

IV. Provider business mailing address

PO BOX 1022
CROWLEY LA
70527-1022
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-3073
  • Fax: 337-783-2548
Mailing address:
  • Phone: 337-783-3073
  • Fax: 337-783-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number05392R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number05392R
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number05392R
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number05392R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: