Provider Demographics
NPI:1922176999
Name:TARVER, ANGELO ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:ANTHONY
Last Name:TARVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22172 SUTTER LN
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-6002
Mailing Address - Country:US
Mailing Address - Phone:225-921-4224
Mailing Address - Fax:
Practice Address - Street 1:22172 SUTTER LN
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-6002
Practice Address - Country:US
Practice Address - Phone:225-921-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.017358208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice