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NPI Code Detail

MEDICARE: DR. RONALD C. WYCHE M.D.

MEDICARE: DR. RONALD C. WYCHE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician012851LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457314494
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD C. WYCHE M.D.
Provider Business Mailing Address
First Line : 804 N BEECH ST
Second Line :
City : TALLULAH
State : LA
Zip : 71282-3809
Country : US
Telephone Number : 318-574-1453
Fax Number : 318-574-5876
Provider Business Practice Location Address
First Line : 804 N BEECH ST
Second Line :
City : TALLULAH
State : LA
Zip : 71282-3809
Country : US
Telephone Number : 318-574-1453
Fax Number : 318-574-5876
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2006
Last Update Date : 12/19/2011

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