Healthcare Provider Details

I. General information

NPI: 1528122579
Provider Name (Legal Business Name): KEN THOMAS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 CYPRESS ST
SULPHUR LA
70663-5052
US

IV. Provider business mailing address

622 CYPRESS ST
SULPHUR LA
70663-5052
US

V. Phone/Fax

Practice location:
  • Phone: 337-527-2491
  • Fax: 337-528-2749
Mailing address:
  • Phone: 337-527-2491
  • Fax: 337-528-2749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200106
License Number StateLA

VIII. Authorized Official

Name: KEN L THOMAS
Title or Position: OWNER
Credential: M.D.
Phone: 337-527-2491