Healthcare Provider Details

I. General information

NPI: 1801001227
Provider Name (Legal Business Name): LAURA ELIZABETH MUTTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1978 INDUSTRIAL BLVD
HOUMA LA
70363-7055
US

IV. Provider business mailing address

1978 INDUSTRIAL BLVD
HOUMA LA
70363-7055
US

V. Phone/Fax

Practice location:
  • Phone: 714-321-0407
  • Fax:
Mailing address:
  • Phone: 714-321-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.202246
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.202246
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.202246
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: