Individual
DR. MATTHEW ALLEN STAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5000 HENNESSY BLVD, BATON ROUGE, LA 70808-4375
(225) 757-0552
(225) 763-9997
Mailing address
8230 SUMMA AVE STE C, BATON ROUGE, LA 70809-3465
(225) 757-0552
(225) 763-9997
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
203735
LA
2085R0202X
Diagnostic Radiology Physician
M6407
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2116398
—
LA
01
—
4P152
MEDICARE PROVIDER NUMBER
LA
Enumeration date
10/18/2007
Last updated
01/11/2015
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