Organization
CODY TINGLE MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CODY TINGLE MD (PHYSICIAN)
(318) 208-1804
Entity
Organization
Contact information
Practice address
535 PIERREMONT RD, SHREVEPORT, LA 71106-2207
(318) 208-1804
Mailing address
PO BOX 19284, SHREVEPORT, LA 71149-0284
(318) 773-0657
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2189328
—
LA
Enumeration date
01/26/2020
Last updated
01/26/2020
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