Individual
WYCHE TAYLOR COLEMAN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2530 BERT KOUNS INDUSTRIAL LOOP STE 116, SHREVEPORT, LA 71118-3153
(318) 212-5901
(318) 212-5905
Mailing address
2611 GREENWOOD RD, DEPARTMENT OF FAMILY MEDICINE, SHREVEPORT, LA 71103-3907
(318) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD.203333
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09976
—
LA
Enumeration date
05/29/2007
Last updated
06/22/2021
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