Provider Demographics
NPI:1437357647
Name:CORWIN ASHFORD GORDON THOMAS PC, INC
Entity type:Organization
Organization Name:CORWIN ASHFORD GORDON THOMAS PC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CROWIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:337-234-3163
Mailing Address - Street 1:802 E FARREL RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7208
Mailing Address - Country:US
Mailing Address - Phone:337-234-3163
Mailing Address - Fax:337-234-3168
Practice Address - Street 1:802 E FARREL RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7208
Practice Address - Country:US
Practice Address - Phone:337-234-3163
Practice Address - Fax:337-234-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA091743027AOtherBLUE CROSS BLUE SHIELD
LA19D1037737OtherCLIA
LA1129453Medicaid
LA1129453Medicaid
LA5CN57Medicare PIN
LA19D1037737OtherCLIA