Individual
JEFFREY TANITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1136A N PINE RD, OLLA, LA 71465-4804
(318) 495-3880
(318) 495-3882
Mailing address
1136A N PINE RD, OLLA, LA 71465-4804
(318) 495-3880
(318) 495-3882
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200484
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1054356
—
LA
05
—
1449342
—
LA
Enumeration date
06/11/2006
Last updated
09/22/2014
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