Demontrell Oneil Thomas
Individual provider Active NPI Driver · Shreveport, LA
NPI 1760064802 · NPPES record last updated Apr 27, 2021
Key facts
- NPI
- 1760064802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 010250952 (LA)
- Practice address
- 4712 Arnsdale Cir
Shreveport, LA 71109-6202 - Phone
- (318) 286-1338
- NPI assigned
- Apr 27, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010250952 | LA | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 010250952 | LA | Yes |
Addresses
Primary practice location
4712 Arnsdale Cir
Shreveport, LA 71109-6202
Mailing address
4712 Arnsdale Cir
Shreveport, LA 71109-6202
Phone (318) 286-1338
Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.