Healthcare Provider Details

I. General information

NPI: 1366536096
Provider Name (Legal Business Name): THOMAS CHARLES DANSBY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: N/A N/A N/A

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S 2ND ST
MONROE LA
71201-8537
US

IV. Provider business mailing address

100 S 2ND ST
MONROE LA
71201-8537
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-7836
  • Fax: 318-325-4438
Mailing address:
  • Phone: 318-322-7836
  • Fax: 318-325-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number020461
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: