Provider Demographics
NPI:1598752875
Name:MATHEWS, GARY L (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:MATHEWS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:141 RIDGEWAY DR
Mailing Address - Street 2:STE 201
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3402
Mailing Address - Country:US
Mailing Address - Phone:337-981-2277
Mailing Address - Fax:337-981-2202
Practice Address - Street 1:935 CAMELLIA BLVD
Practice Address - Street 2:STE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6961
Practice Address - Country:US
Practice Address - Phone:337-504-5000
Practice Address - Fax:337-504-5646
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2020-03-11
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Provider Licenses
StateLicense IDTaxonomies
LA0194492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA990005847OtherRAILROAD MEDICARE
LA1390763Medicaid
LA1390763Medicaid
LAE12187Medicare UPIN