Healthcare Provider Details

I. General information

NPI: 1841275534
Provider Name (Legal Business Name): WILLIAM LYLE TERRAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/09/2007
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: 985-971-9418
Mailing address:
  • Phone: 985-893-2580
  • Fax: 985-971-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: