Provider Demographics
NPI:1629064019
Name:TYLER, HAROLD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:DAVID
Last Name:TYLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-3202
Mailing Address - Country:US
Mailing Address - Phone:318-927-2024
Mailing Address - Fax:318-927-3723
Practice Address - Street 1:620 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-3202
Practice Address - Country:US
Practice Address - Phone:318-927-2024
Practice Address - Fax:318-927-3723
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016382208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1358266Medicaid
LA1358266Medicaid
LA51237Medicare ID - Type Unspecified