Individual
DR. MARVIN BARCO MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4600 AMBASSADOR CAFFERY PKWY, LAFAYETTE, LA 70508-6902
(337) 470-2605
(337) 470-4595
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(337) 470-2605
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
MD203581
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124281852
BLUE CROSS BLUE SHIELD
LA
05
—
2120336
—
LA
Enumeration date
07/02/2008
Last updated
08/02/2024
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