Individual
TYLER NICHOLAS CARRUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
8742 GOODWOOD BLVD, BATON ROUGE, LA 70806-7915
(225) 893-0810
Mailing address
PO BOX 44158, BATON ROUGE, LA 70804-4158
(281) 787-4362
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.A10424
LA
363A00000X
Physician Assistant
PA03418
TX
Other
Enumeration date
10/28/2008
Last updated
10/28/2008
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