Healthcare Provider Details

I. General information

NPI: 1265096390
Provider Name (Legal Business Name): THOMAS G. BLOCK III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 06/19/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MCMILLAN RD
WEST MONROE LA
71291-5327
US

IV. Provider business mailing address

503 MCMILLAN RD
WEST MONROE LA
71291-5327
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number337406
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: