Organization
DIXON CORRECTIONAL INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELO ANTHONY TARVER M.D. (MEDICAL DIRECTOR)
(225) 634-6311
Entity
Organization
Contact information
Practice address
5085 CREEK VALLEY DR, ZACHARY, LA 70791-3073
(225) 610-7403
Mailing address
5085 CREEK VALLEY DR, ZACHARY, LA 70791
(225) 610-7403
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
AP07348
LA
Other
Enumeration date
09/19/2013
Last updated
09/19/2013
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