Healthcare Provider Details

I. General information

NPI: 1558580357
Provider Name (Legal Business Name): THOMAS A REILLY MD APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 MARGARET PL
SHREVEPORT LA
71101-4521
US

IV. Provider business mailing address

PO BOX 1768
SHREVEPORT LA
71116-1768
US

V. Phone/Fax

Practice location:
  • Phone: 318-222-8187
  • Fax: 318-424-2637
Mailing address:
  • Phone: 318-677-7450
  • Fax: 318-425-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS A REILLY
Title or Position: OWNER
Credential: MD
Phone: 318-222-8187