Provider Demographics
NPI:1568637940
Name:THOMAS H FIELDS JR MD LLC
Entity type:Organization
Organization Name:THOMAS H FIELDS JR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-387-0551
Mailing Address - Street 1:405 ROSELAWN AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5345
Mailing Address - Country:US
Mailing Address - Phone:318-387-0551
Mailing Address - Fax:318-322-1961
Practice Address - Street 1:405 ROSELAWN AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5345
Practice Address - Country:US
Practice Address - Phone:318-387-0551
Practice Address - Fax:318-322-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1068781Medicaid