Individual
DR. JUSTIN MICHAEL TENNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
604 N. ACADIA STE 101, THIBODAUX, LA 70301-4897
(985) 446-5079
(985) 447-2497
Mailing address
604 NORTH ACADIA STE 101, THIBODAUX, LA 70301-4897
(985) 446-5079
(985) 447-2497
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
026037
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026037
LA LICENSE
LA
05
—
1056707
—
LA
01
—
4J3246746
OTHER
—
Enumeration date
05/21/2007
Last updated
04/24/2024
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