# KENNETH P. MAUTERER MD A MEDICAL CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205018017
- **Authorized official:** DR. KENNETH P MAUTERER MD (PRESIDENT)
- **Authorized official phone:** (318) 495-3131

## Contact information

- **Practice address:** 1148 N PINE ROAD, OLLA, LA 71465
- **Practice address phone:** (318) 495-3131
- **Practice address fax:** (318) 495-3677
- **Mailing address:** PO BOX 668, OLLA, LA 71465-0668
- **Mailing address phone:** (318) 495-3131
- **Mailing address fax:** (318) 495-3677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 012667 | LA | Yes |

## Other

- **Enumeration date:** 12/04/2007
- **Last updated:** 12/04/2007