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General NPI Number Information
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NPI Number | 1326533621
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Entity Type | Individual
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Provider Name | MATTHEW MAGNONE DO
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Gender | Male
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 10/13/2024
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Provider Practice Location Address
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Address Line | 1305 CROWLEY RAYNE HWY
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City | CROWLEY
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State | LA
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Zip | 70526-8202
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Country | US
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Telephone | 337-354-1153
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Fax |
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Provider Business Mailing Address
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Address Line | 102 LOMOND AVE
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City | LAFAYETTE
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State | LA
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Zip | 70508-4818
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Country | US
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Telephone | 304-479-2779
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 343002
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License Number State | LA
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