Healthcare Provider Details

I. General information

NPI: 1780033068
Provider Name (Legal Business Name): FMC ASSOCIATES OF NEW IBERIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 E MAIN ST SUITE 400
NEW IBERIA LA
70560-4046
US

IV. Provider business mailing address

2309 E MAIN ST SUITE 400
NEW IBERIA LA
70560-4046
US

V. Phone/Fax

Practice location:
  • Phone: 337-367-0271
  • Fax: 337-364-6139
Mailing address:
  • Phone: 337-367-0271
  • Fax: 337-364-6139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number015812
License Number StateLA

VIII. Authorized Official

Name: DR. JOSE MATA
Title or Position: GENERAL PARTNER
Credential: M.D.
Phone: 337-367-0271