Provider Demographics
NPI:1548584550
Name:COURVILLE, MATTHEW ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ROSS
Last Name:COURVILLE
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:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:KINDER
Mailing Address - State:LA
Mailing Address - Zip Code:70648-0637
Mailing Address - Country:US
Mailing Address - Phone:337-738-3500
Mailing Address - Fax:
Practice Address - Street 1:208 6TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:KINDER
Practice Address - State:LA
Practice Address - Zip Code:70648-3186
Practice Address - Country:US
Practice Address - Phone:337-738-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine