Individual
RUSSELL WAYNE TYNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
460 ASHLEY RIDGE BLVD, 500, SHREVEPORT, LA 71106-7228
(318) 212-1610
(866) 455-7515
Mailing address
460 ASHLEY RIDGE BLVD, 500, SHREVEPORT, LA 71106-7228
(318) 212-1610
(866) 455-7515
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
016884
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1351661
—
LA
Enumeration date
07/07/2006
Last updated
04/29/2009
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