Healthcare Provider Details

I. General information

NPI: 1821271917
Provider Name (Legal Business Name): WILLIAM H MATTHEWS, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 THOMAS RD STE 104
WEST MONROE LA
71291-7365
US

IV. Provider business mailing address

3308 DEBORAH DR
MONROE LA
71201-2151
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-1559
  • Fax: 318-325-5084
Mailing address:
  • Phone: 318-325-7431
  • Fax: 318-325-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number016854
License Number StateLA

VIII. Authorized Official

Name: BRENDA ROBERTS
Title or Position: BILLING MGR
Credential:
Phone: 318-396-2715