Provider Demographics
NPI:1447220660
Name:HUGHES, MATTHEW E (CRNA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:HUGHES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 W MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5547
Mailing Address - Country:US
Mailing Address - Phone:337-478-0511
Mailing Address - Fax:337-478-5644
Practice Address - Street 1:424 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5547
Practice Address - Country:US
Practice Address - Phone:337-478-0511
Practice Address - Fax:337-478-5644
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56602207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA430016737OtherRAILROAD MEDICARE PIN
LA1923389Medicaid
LA430016737OtherRAILROAD MEDICARE PIN
LA56437Medicare ID - Type Unspecified