MEDICARE: DR. PAUL MATTHEWS VAN DEVENTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	10083R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730184193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MATTHEWS VAN DEVENTER M.D.

Provider Business Mailing Address
First Line	:	2330 N CAUSEWAY BLVD
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-6402
Country	:	US
Telephone Number	:	985-674-1700
Fax Number	:	985-674-1722

Provider Business Practice Location Address
First Line	:	2330 N CAUSEWAY BLVD
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-6402
Country	:	US
Telephone Number	:	985-674-1700
Fax Number	:	985-674-1722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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