Individual
MR. TYLER SAMUEL WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3330 MASONIC DR, ALEXANDRIA, LA 71301-3841
(318) 487-1122
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
329005
LA
Other
Enumeration date
10/11/2021
Last updated
10/11/2021
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