Individual
THOMAS E SOUTHERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3520 GUION RD, STE 301, INDIANAPOLIS, IN 46222-1672
(317) 926-1356
(317) 926-1465
Mailing address
PO BOX 637999, CINCINNATI, OH 45263-7999
(317) 682-2030
(317) 644-5060
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
01023497A
IN
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
01023497A
IN
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
01023497A
IN
2086S0105X
Surgery of the Hand (Surgery) Physician
01023497A
IN
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
01023497A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000762785
BCBS
IN
05
—
100073340A
—
IN
Enumeration date
11/08/2006
Last updated
03/19/2013
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