Provider Demographics
NPI:1093034373
Name:MAUTERER, JEROME CHARLES SR (CSTFA)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:CHARLES
Last Name:MAUTERER
Suffix:SR
Gender:M
Credentials:CSTFA
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Mailing Address - Street 1:PO BOX 6345
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70469-6345
Mailing Address - Country:US
Mailing Address - Phone:985-445-6902
Mailing Address - Fax:985-781-4872
Practice Address - Street 1:201 TERRELL DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-3433
Practice Address - Country:US
Practice Address - Phone:985-445-6902
Practice Address - Fax:985-781-4872
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2018-10-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant