Provider Demographics
NPI:1386670891
Name:MATHERS, TERRENCE LENOIR (MD)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:LENOIR
Last Name:MATHERS
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 1:524 MARIGNY AVE
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5240
Mailing Address - Country:US
Mailing Address - Phone:985-951-1007
Mailing Address - Fax:
Practice Address - Street 1:524 MARIGNY AVE
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5240
Practice Address - Country:US
Practice Address - Phone:985-373-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL020886207R00000X, 207P00000X
LAMD.020886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF44988Medicare UPIN