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Organization

WILLIAM WILDER, APMC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. TINA T LEVRON (CLINIC ADMINSTRATOR)
(985) 868-1810
Entity
Organization

Contact information

Practice address
12 PROFESSIONAL DR, HOUMA, LA 70360-4046
(985) 868-1810
(985) 876-3670
Mailing address
12 PROFESSIONAL DR, HOUMA, LA 70360-4046
(985) 868-1810
(985) 876-3670

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
11220
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1129241
LA
Enumeration date
04/28/2010
Last updated
04/28/2010
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