Provider Demographics
NPI:1780735514
Name:PERIOU, THOMAS LOUIS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:LOUIS
Last Name:PERIOU
Suffix:
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 1:198 BELLE TERRE BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4758
Mailing Address - Country:US
Mailing Address - Phone:985-892-0592
Mailing Address - Fax:
Practice Address - Street 1:198 BELLE TERRE BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4758
Practice Address - Country:US
Practice Address - Phone:985-892-0592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD015194207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1324884Medicaid
LAB65355Medicare UPIN
LA54625Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER