MEDICARE: DR. CLYDE R ROY III MD

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
1	208800000X	Urology Physician	016789	LA

Other Identifiers

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

General Provider Information

NPI Number	:	1720085699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLYDE R ROY III MD

Provider Business Mailing Address
First Line	:	602 N LEWIS ST
Second Line	:	SUITE 400
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2093
Country	:	US
Telephone Number	:	337-365-4113
Fax Number	:	307-365-4115

Provider Business Practice Location Address
First Line	:	602 N LEWIS ST
Second Line	:	SUITE 400
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2093
Country	:	US
Telephone Number	:	337-365-4113
Fax Number	:	307-365-4115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	07/08/2007

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