Provider Demographics
NPI:1740287481
Name:MATIS, RICHARD E (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:MATIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4809 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6917
Mailing Address - Country:US
Mailing Address - Phone:337-988-8811
Mailing Address - Fax:337-988-8844
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6917
Practice Address - Country:US
Practice Address - Phone:337-988-8811
Practice Address - Fax:337-988-8844
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-08-06
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Provider Licenses
StateLicense IDTaxonomies
LA013821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1194271Medicaid
LA080056423OtherPALMETTO GBA - RAILROAD M
LA1194271Medicaid
LA080056423OtherPALMETTO GBA - RAILROAD M