Provider Demographics
NPI:1558650861
Name:PRINE, MATTHEW DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DANIEL
Last Name:PRINE
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 1:1012 LOUISA ST
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-2957
Mailing Address - Country:US
Mailing Address - Phone:318-728-2046
Mailing Address - Fax:318-728-9371
Practice Address - Street 1:1012 LOUISA ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-2957
Practice Address - Country:US
Practice Address - Phone:318-728-2046
Practice Address - Fax:318-728-9371
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA205904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine