Healthcare Provider Details

I. General information

NPI: 1164927539
Provider Name (Legal Business Name): DEXTER MATRANA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 TULANE AVENUE
NEW ORLEANS LA
70112
US

IV. Provider business mailing address

1542 TULANE AVE FL 4
NEW ORLEANS LA
70112-2865
US

V. Phone/Fax

Practice location:
  • Phone: 504-962-6110
  • Fax: 504-962-6111
Mailing address:
  • Phone: 504-962-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number322612
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number322612
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: