Provider Demographics
NPI:1366453672
Name:MATTHEWS, WILLIAM H (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:3308 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2151
Mailing Address - Country:US
Mailing Address - Phone:318-325-7431
Mailing Address - Fax:318-325-2123
Practice Address - Street 1:102 THOMAS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7366
Practice Address - Country:US
Practice Address - Phone:318-323-1559
Practice Address - Fax:318-325-5084
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016854207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1367079Medicaid
LA53036Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
LA1367079Medicaid
LAP00170741Medicare PIN