Healthcare Provider Details

I. General information

NPI: 1508824764
Provider Name (Legal Business Name): WILLIAM ERNEST TYNDALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 PELHAM RD S
JACKSONVILLE AL
36265-3353
US

IV. Provider business mailing address

200 CORPORATE BLVD
LAFAYETTE LA
70508-3870
US

V. Phone/Fax

Practice location:
  • Phone: 256-413-1032
  • Fax:
Mailing address:
  • Phone: 800-893-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number11265
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: