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1851323810
RUSSELL WAYNE TYNES
SHREVEPORT, LA
NPI
1851323810
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
207R00000X Internal Medicine
(Licence: LA 016884)
Enumeration Date
2006-07-07
Last Update Date
2009-04-29
Business Address
-- RUSSELL WAYNE TYNES MD
460 ASHLEY RIDGE BLVD 500
SHREVEPORT, LA 71106-7228
Phone number: 318-212-1610
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Mailing Address
-- RUSSELL WAYNE TYNES MD
460 ASHLEY RIDGE BLVD 500
SHREVEPORT, LA 71106-7228
Phone number: 318-212-1610
Copy
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