Provider Demographics
NPI:1144228768
Name:MAUTNER, RICHARD K (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
Last Name:MAUTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 CANAL ST
Mailing Address - Street 2:FL 1
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6302
Mailing Address - Country:US
Mailing Address - Phone:504-821-8158
Mailing Address - Fax:504-827-7416
Practice Address - Street 1:2820 CANAL ST
Practice Address - Street 2:FL 1
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6302
Practice Address - Country:US
Practice Address - Phone:504-821-8158
Practice Address - Fax:504-827-7416
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03880R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1184675Medicaid
LA1184675Medicaid
LAB60691Medicare UPIN