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General NPI Number Information
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NPI Number | 1902800246
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Entity Type | Individual
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Provider Name | HENRY MATTHEW PELTIER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 604 N ACADIA RD STE 200
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City | THIBODAUX
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State | LA
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Zip | 70301-4897
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Country | US
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Telephone | 985-448-3700
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Fax | 985-448-3900
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Provider Business Mailing Address
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Address Line | 604 N ACADIA RD STE 200
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City | THIBODAUX
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State | LA
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Zip | 70301-4897
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Country | US
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Telephone | 985-448-3700
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Fax | 985-448-3900
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD020901
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License Number State | LA
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