Individual
DR. JOHN MATHEW EDAVETTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
441 HEYMANN BLVD, LAFAYETTE, LA 70503-2611
(337) 289-8429
(337) 289-8431
Mailing address
441 HEYMANN BLVD, LAFAYETTE, LA 70503-2611
(337) 289-8429
(337) 289-8431
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
021589
LA
207RI0011X
Interventional Cardiology Physician
Primary
021589
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205241001
—
AR
Enumeration date
02/03/2006
Last updated
05/23/2019
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