Provider Demographics
NPI:1689679615
Name:TEAFORD, THADDEUS LAMAR (MD)
Entity type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:LAMAR
Last Name:TEAFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8861
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70011-8861
Mailing Address - Country:US
Mailing Address - Phone:985-405-5200
Mailing Address - Fax:985-405-5201
Practice Address - Street 1:1495 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2205
Practice Address - Country:US
Practice Address - Phone:985-405-5200
Practice Address - Fax:985-405-5201
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0116872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1302155Medicaid
LA1302155Medicaid
E91952Medicare UPIN