Provider Demographics
NPI:1225176167
Name:MATTE, BRAD JOSEPH
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:JOSEPH
Last Name:MATTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 DAVID DR
Mailing Address - Street 2:#116
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1396
Mailing Address - Country:US
Mailing Address - Phone:985-397-0461
Mailing Address - Fax:985-385-1415
Practice Address - Street 1:800 DAVID DR
Practice Address - Street 2:#116
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1396
Practice Address - Country:US
Practice Address - Phone:985-397-0461
Practice Address - Fax:985-385-1415
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5396120001Medicare ID - Type Unspecified