Provider Demographics
NPI:1336191378
Name:MATHIS, JEAN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ANN
Last Name:MATHIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 WESTBANK EXPY
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2802
Mailing Address - Country:US
Mailing Address - Phone:504-827-1722
Mailing Address - Fax:504-827-1724
Practice Address - Street 1:6000 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2802
Practice Address - Country:US
Practice Address - Phone:504-827-1722
Practice Address - Fax:504-827-1724
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08422R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1981141Medicaid
AL000077108Medicaid
LA1981141Medicaid
4Q204Medicare PIN
ALF78210Medicare UPIN