Individual
TREY M HAROLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1500 LINE AVENUE, SUITE 100, SHREVEPORT, LA 71101-4639
(318) 635-3052
(318) 635-3072
Mailing address
1534 ELIZABETH AVE STE 301, SHREVEPORT, LA 71101-4531
(318) 629-5001
(318) 629-5020
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
200316
LA
363A00000X
Physician Assistant
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00906263
RR
LA
Enumeration date
08/10/2009
Last updated
07/31/2020
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