Individual
BLAINE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8212 KELWOOD AVE, BATON ROUGE, LA 70806-4801
(225) 929-7600
(225) 930-7524
Mailing address
2644 S SHERWOOD FOREST BLVD, STE 121, BATON ROUGE, LA 70816-2248
(225) 293-2523
(225) 293-1807
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
10076R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050071038
RR MEDICARE PROVIDER NUMB
LA
05
—
1693316
—
LA
01
—
721435817T
HUMANA PROVIDER NUMBER
LA
01
—
G44006
STERLING PROVIDER NUMBER
LA
Enumeration date
10/06/2006
Last updated
03/29/2017
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