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Individual

TIMOTHY TYLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
706 ROSS ST, OAK GROVE, LA 71263-9798
(318) 428-3237
Mailing address
706 ROSS ST, OAK GROVE, LA 71263-9798
(318) 428-3237

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
A10415
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1625086
LA
Enumeration date
10/04/2006
Last updated
07/08/2007
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