Individual
TIMOTHY E MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8383 MILLICENT WAY, SHREVEPORT, LA 71115-5207
(318) 797-6661
(318) 795-8512
Mailing address
8383 MILLICENT WAY, SHREVEPORT, LA 71115-5207
(318) 797-6661
(318) 795-8512
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
07536R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080039492
RR MEDICARE
—
05
—
1376884
—
LA
01
—
2712976009
CIGNA
LA
01
—
5843480
AETNA
LA
01
—
B005
TRICARE
LA
Enumeration date
06/22/2005
Last updated
05/08/2024
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