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General NPI Number Information
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NPI Number | 1811324742
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Entity Type | Organization
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Legal Business Name | MATTHEW R COURVILLE MD LLC
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Dates
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Enumeration Date | 10/09/2013
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 208 6TH AVE STE 4
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City | KINDER
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State | LA
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Zip | 70648-3186
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Country | US
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Telephone | 337-738-3500
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Fax | 337-335-0856
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Provider Business Mailing Address
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Address Line | PO BOX 637
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City | KINDER
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State | LA
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Zip | 70648-0637
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Country | US
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Telephone | 337-738-3500
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Fax | 337-335-0856
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Authorized Official
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Title or Position | MD
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Name | DR. MATTHEW R COURVILLE
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Credential | MD
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Telephone | 337-738-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 204708
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License Number State | LA
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