Healthcare Provider Details

I. General information

NPI: 1285950063
Provider Name (Legal Business Name): CRAIG M. MATHERNE, M.D., A.P.M.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 HIGHWAY 190 SUITE P
EUNICE LA
70535-5135
US

IV. Provider business mailing address

3521 HIGHWAY 190 SUITE P
EUNICE LA
70535-5135
US

V. Phone/Fax

Practice location:
  • Phone: 337-457-8040
  • Fax: 337-457-8043
Mailing address:
  • Phone: 337-457-8040
  • Fax: 337-457-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number13221R
License Number StateLA

VIII. Authorized Official

Name: DR. CRAIG MICHAEL MATHERNE
Title or Position: OWNER
Credential: M.D.
Phone: 337-457-8040