MEDICARE: GEORGE G MATEWERE 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	207Q00000X	Family Medicine Physician	M1230	TX

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	:	1548257363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE G MATEWERE MD

Provider Business Mailing Address
First Line	:	1790 SATURN ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70129-2270
Country	:	US
Telephone Number	:	504-253-4674
Fax Number	:	504-253-4717

Provider Business Practice Location Address
First Line	:	1790 SATURN DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70129-2270
Country	:	US
Telephone Number	:	504-253-4674
Fax Number	:	504-253-4717

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	06/03/2010

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