Healthcare Provider Details

I. General information

NPI: 1619617396
Provider Name (Legal Business Name): MATTHEW JARRED TRAHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6917
US

IV. Provider business mailing address

102 WESTBERRY CIR
LAFAYETTE LA
70508-5620
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-2911
  • Fax:
Mailing address:
  • Phone: 337-322-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number346656
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: