Individual
DR. RYAN JOSEPH MATHERNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
416 HIGHWAY 308, THIBODAUX, LA 70301-5752
(985) 446-5888
(985) 446-5880
Mailing address
951 HIGHWAY 654, MATHEWS, LA 70375-2025
(504) 450-9966
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD.202680
LA
207N00000X
Dermatology Physician
N3169
TX
207ND0900X
Dermatopathology Physician
MD.202680
LA
207ND0900X
Dermatopathology Physician
N3169
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1500615
—
LA
01
—
5C904
MEDICARE GROUP PIN
LA
Enumeration date
08/05/2007
Last updated
11/30/2022
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