Provider Demographics
NPI:1720085699
Name:ROY, CLYDE R III (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:R
Last Name:ROY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:602 N LEWIS ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2093
Mailing Address - Country:US
Mailing Address - Phone:337-365-4113
Mailing Address - Fax:307-365-4115
Practice Address - Street 1:602 N LEWIS ST
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2093
Practice Address - Country:US
Practice Address - Phone:337-365-4113
Practice Address - Fax:307-365-4115
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA016789208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1969290Medicaid
LA1969290Medicaid
LA5R492B899Medicare ID - Type Unspecified