Provider Demographics
NPI:1033315742
Name:COPPLE, MATTHEW DUANE (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DUANE
Last Name:COPPLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 SAINT CLAIR BLVD STE 1020
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5027
Mailing Address - Country:US
Mailing Address - Phone:225-743-2000
Mailing Address - Fax:225-743-2010
Practice Address - Street 1:1014 SAINT CLAIR BLVD STE 1020
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5027
Practice Address - Country:US
Practice Address - Phone:225-743-2000
Practice Address - Fax:225-743-2010
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADO.000290207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1992983092OtherGROUP NPI