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General NPI Number Information
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NPI Number | 1326043084
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Entity Type | Individual
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Provider Name | CHARLES W. THOMAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 07/08/2016
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Provider Practice Location Address
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Address Line | 1200 AVENUE G
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City | MARRERO
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State | LA
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Zip | 70072-3765
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Country | US
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Telephone | 504-349-6713
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Fax | 504-349-6733
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Provider Business Mailing Address
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Address Line | 1200 AVENUE G
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City | MARRERO
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State | LA
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Zip | 70072-3765
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Country | US
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Telephone | 504-834-0626
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Fax | 504-833-9480
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 10747R
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License Number State | LA
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