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General NPI Number Information
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NPI Number | 1013949619
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Entity Type | Individual
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Provider Name | MATTI W PALO JR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 70411 HIGHWAY 21
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City | COVINGTON
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State | LA
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Zip | 70433-8103
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Country | US
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Telephone | 985-400-5566
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Fax | 985-400-5560
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Provider Business Mailing Address
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Address Line | 5959 S SHERWOOD FOREST BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70816-6038
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Country | US
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Telephone | 225-765-5727
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD.025221
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License Number State | LA
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