Individual
DR. ERIC DWAYNE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5000
Mailing address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301086709
MI
207R00000X
Internal Medicine Physician
Primary
MD.203472
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1809110
—
LA
01
—
4M586F600
MEDICARE - PTAN
LA
Enumeration date
06/21/2008
Last updated
03/31/2015
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