Individual
CHARLES THERIOT TEXADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2495 SHREVEPORT HWY, PINEVILLE, LA 71360-4044
(318) 473-0010
(318) 483-5058
Mailing address
2495 SHREVEPORT HWY, PINEVILLE, LA 71360-4044
(318) 473-0010
(318) 483-5058
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD020412
LA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD020412
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1652989
—
LA
01
—
200026321
RAILROAD MEDICARE-PALMETT
LA
Enumeration date
03/02/2006
Last updated
10/12/2023
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