Provider Demographics
NPI:1407348352
Name:MCGUFFEE, MATTHEW D (NP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:MCGUFFEE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:318-966-6800
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:312 GRAMMONT ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7457
Practice Address - Country:US
Practice Address - Phone:318-966-6800
Practice Address - Fax:318-966-6801
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09984363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2475703Medicaid