Individual
TYMWA DUVAL DIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4700 SHREVEPORT BLANCHARD HWY, SHREVEPORT, LA 71107-4702
(318) 221-1001
(318) 221-1044
Mailing address
4700 SHREVEPORT BLANCHARD HWY, SHREVEPORT, LA 71107-4702
(318) 221-1001
(318) 221-1044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
023630
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1482757
—
LA
Enumeration date
06/23/2006
Last updated
06/23/2021
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