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General NPI Number Information
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NPI Number | 1083683692
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Entity Type | Organization
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Legal Business Name | THOMAS L. EWING MD, APMC
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1212 RIVERVIEW BLVD SUITE 3000
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City | GONZALES
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State | LA
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Zip | 70737-5023
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Country | US
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Telephone | 225-743-2444
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Fax | 225-743-2448
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Provider Business Mailing Address
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Address Line | 1212 RIVERVIEW BLVD SUITE 3000
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City | GONZALES
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State | LA
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Zip | 70737-5023
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Country | US
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Telephone | 225-743-2444
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Fax | 225-743-2448
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS L. EWING
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Credential | MD
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Telephone | 225-743-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 02654
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License Number State | LA
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