Healthcare Provider Details

I. General information

NPI: 1508007584
Provider Name (Legal Business Name): MATTHEW SCOTT BUZHARDT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HENNESSY BLVD 1ST FLOOR OF HOSPITAL
BATON ROUGE LA
70808-4375
US

IV. Provider business mailing address

5000 HENNESSY BLVD 1ST FLOOR OF HOSPITAL
BATON ROUGE LA
70808-4375
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-4050
  • Fax: 225-765-4046
Mailing address:
  • Phone: 225-765-4050
  • Fax: 225-765-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.204512
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.204512
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: