Provider Demographics
NPI:1487652970
Name:TRAWICK, THOMAS STEEN JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STEEN
Last Name:TRAWICK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:STEEN
Other - Last Name:TRAWICK
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8525 LINE AVE, STE A
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-0000
Mailing Address - Country:US
Mailing Address - Phone:318-300-4926
Mailing Address - Fax:318-300-3951
Practice Address - Street 1:8525 LINE AVE
Practice Address - Street 2:STE A
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-0000
Practice Address - Country:US
Practice Address - Phone:318-300-4926
Practice Address - Fax:318-383-3951
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023905207R00000X
LAMD.1023905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1487473Medicaid
LA5H395Medicare ID - Type Unspecified
LA1487473Medicaid
LAH18621Medicare UPIN