Individual
CLYDE D PORTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
377 CHARLES MILLER RD, HORNBECK, LA 71439-1610
(346) 435-4892
Mailing address
377 CHARLES MILLER RD, HORNBECK, LA 71439-1610
(346) 435-4892
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
Primary
—
—
Other
Enumeration date
11/12/2024
Last updated
11/12/2024
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