Individual
BLAINE THOMAS
Active
Individual
BLAINE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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