Healthcare Provider Details

I. General information

NPI: 1841265691
Provider Name (Legal Business Name): WILLIAM L. TERRAL, MD, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71107 HIGHWAY 21 SUITE 1
COVINGTON LA
70433-7151
US

IV. Provider business mailing address

71107 HIGHWAY 21 SUITE 1
COVINGTON LA
70433-7151
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-2580
  • Fax: 985-871-9418
Mailing address:
  • Phone: 985-893-2580
  • Fax: 985-871-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number013850
License Number StateLA

VIII. Authorized Official

Name: DR. WILLIAM LYLE TERRAL
Title or Position: PRESIDENT
Credential: MD
Phone: 985-893-2580