Basic Information
| Provider Information | |||||||||
| NPI: | 1477544815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALDERSON | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5009 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370245009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152213642 | ||||||||
| FaxNumber: | 6153714600 | ||||||||
| Practice Location | |||||||||
| Address1: | 1327 STELLY LANE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | SULPHUR | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375287898 | ||||||||
| FaxNumber: | 3375287427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 01/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 07139R | LA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 1900198 | 01 | LA | UNITED HEALTHCARE | OTHER | 340004858 | 01 | LA | RAILROAD MEDICARE | OTHER | 41480555490 | 01 | LA | BLUE CROSS BLUE SHIELD | OTHER | LA6002281 | 01 | LA | TRICARE | OTHER | 1361674 | 05 | LA | MEDICAID |