Provider Demographics
NPI: | 1407318470 |
---|---|
Name: | CALIGIURI, THOMAS GENE JR (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | THOMAS |
Middle Name: | GENE |
Last Name: | CALIGIURI |
Suffix: | JR |
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: | 1541 KINGS HIGHWAY |
Mailing Address - Street 2: | INTERNAL MEDICINE |
Mailing Address - City: | SHREVEPORT |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 71130-3932 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 318-626-0434 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 500 LIPSCOMB ST |
Practice Address - Street 2: | |
Practice Address - City: | FORT WORTH |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76104-2239 |
Practice Address - Country: | US |
Practice Address - Phone: | 817-870-2616 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2019-04-01 |
Last Update Date: | 2024-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
LA | 332570 | 207R00000X |
390200000X | ||
TX | V2028 | 207RN0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | ||
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |