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NPI Code Detail

MEDICARE: DR. ALFRED JOSEPH THOMAS IV MD

MEDICARE: DR. ALFRED JOSEPH THOMAS IV MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1093400996
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALFRED JOSEPH THOMAS IV MD
Provider Business Mailing Address
First Line : 1501 KINGS HWY
Second Line :
City : SHREVEPORT
State : LA
Zip : 71103-4228
Country : US
Telephone Number : 318-626-0434
Fax Number :
Provider Business Practice Location Address
First Line : 1501 KINGS HWY
Second Line :
City : SHREVEPORT
State : LA
Zip : 71103-4228
Country : US
Telephone Number : 318-626-0434
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2023
Last Update Date : 05/26/2026

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