Individual
DR. TY GLENN HARGRODER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3501 HIGHWAY 190 STE X, EUNICE, LA 70535-5129
(337) 580-7544
Mailing address
PO BOX 407, CHURCH POINT, LA 70525-0407
(337) 684-5232
(337) 684-3434
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
020601
LA
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
020601
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080166458
RR MEDICARE
LA
05
—
1398501
—
LA
01
—
678856
AETNA
LA
01
—
72-1190076
IRS
LA
Enumeration date
05/25/2006
Last updated
05/16/2023
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