Provider Demographics
NPI:1366408809
Name:DOUD, THOMAS M (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:DOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 BY PASS 123
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-4762
Mailing Address - Country:US
Mailing Address - Phone:864-885-0551
Mailing Address - Fax:864-885-1822
Practice Address - Street 1:1059 BY PASS 123
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4762
Practice Address - Country:US
Practice Address - Phone:864-885-0551
Practice Address - Fax:864-885-1822
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC136032085R0202X
NC93003872085R0202X
GA0534582085R0202X
TXH35622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2588Medicaid
SCB926066368Medicare PIN