Provider Demographics
NPI:1841275534
Name:TERRAL, WILLIAM LYLE (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LYLE
Last Name:TERRAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:71107 HIGHWAY 21
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7151
Mailing Address - Country:US
Mailing Address - Phone:985-893-2580
Mailing Address - Fax:985-971-9418
Practice Address - Street 1:71107 HIGHWAY 21
Practice Address - Street 2:SUITE 1
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7151
Practice Address - Country:US
Practice Address - Phone:985-893-2580
Practice Address - Fax:985-971-9418
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA013850208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1164844Medicaid