Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 321084 | LA |
NPI | 1003310897 |
---|---|
Provider Name | Dr. Ronald Tyler Hebert |
First Address | Erath, LA 70533-5471 |
Second Address | Lafayette, LA 70506-4205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2018 |
Last Update Date | 25/02/2020 |