Individual
MR. MATTHEW BRUHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
15813 PAUL VEGA MD DR STE 100, HAMMOND, LA 70403-1431
(985) 230-2663
(985) 230-2665
Mailing address
PO BOX 3087, HAMMOND, LA 70404-3087
(985) 230-3668
(985) 370-7409
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1179318
LA
363A00000X
Physician Assistant
Primary
324782
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2541668
—
LA
Enumeration date
10/12/2020
Last updated
05/22/2024
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