Basic Information
Provider Information | |||||||||
NPI: | 1922209139 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | THOMAS | ||||||||
FirstName: | MOLLY | ||||||||
MiddleName: | BOYD | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BOYD | ||||||||
OtherFirstName: | MOLLY | ||||||||
OtherMiddleName: | LEIGH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1211 COOLIDGE BLVD | ||||||||
Address2: | SUITE 100 | ||||||||
City: | LAFAYETTE | ||||||||
State: | LA | ||||||||
PostalCode: | 705032636 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3372898400 | ||||||||
FaxNumber: | 3372898401 | ||||||||
Practice Location | |||||||||
Address1: | 1211 COOLIDGE BLVD | ||||||||
Address2: | SUITE 100 | ||||||||
City: | LAFAYETTE | ||||||||
State: | LA | ||||||||
PostalCode: | 705032636 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3372898400 | ||||||||
FaxNumber: | 3372898401 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/29/2007 | ||||||||
LastUpdateDate: | 09/25/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 200913 | LA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | MD.200913 | LA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RH0003X | MD.200913 | LA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | 176811001 | 05 | AR |   | MEDICAID | 1092789 | 05 | LA |   | MEDICAID | 09278 | 05 | LA |   | MEDICAID | 203958801 | 05 | TX |   | MEDICAID |