Individual
MATTHEW TYLER HALTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
16201 THORNCROWN LN, BATON ROUGE, LA 70816-3257
(318) 820-1071
Mailing address
16201 THORNCROWN LN, BATON ROUGE, LA 70816-3257
(318) 820-1071
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
LA
Other
Enumeration date
07/07/2025
Last updated
07/07/2025
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