Individual
JOSEPH R. TYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 LINE AVE STE 204, SHREVEPORT, LA 71101-4648
(318) 300-4926
(318) 383-3951
Mailing address
PO BOX 52364, SHREVEPORT, LA 71135-2364
(318) 798-4539
(318) 798-4601
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
025002
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1423611
—
LA
Enumeration date
06/16/2006
Last updated
05/24/2022
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