Individual
ELIZABETH L MATERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
155 BRICKLAYER STREET, OLIVE HILL, KY 41164
(606) 286-4152
(606) 286-2385
Mailing address
PO BOX 1268, OLIVE HILL, KY 41164-1268
(606) 286-4152
(606) 286-2385
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
47594
KY
390200000X
Student in an Organized Health Care Education/Training Program
58997
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47594
KY MEDICAL LICENSE
KY
05
—
7100313530
—
KY
Enumeration date
05/13/2011
Last updated
09/22/2015
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