Healthcare Provider Details

I. General information

NPI: 1811022460
Provider Name (Legal Business Name): TA YU HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SERIO BLVD
FERRIDAY LA
71334
US

IV. Provider business mailing address

1857 HWY 568
FERRIDAY LA
71334
US

V. Phone/Fax

Practice location:
  • Phone: 318-757-7626
  • Fax: 318-757-7626
Mailing address:
  • Phone: 318-757-7626
  • Fax: 318-757-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD03721R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: