Individual
JOHN ALEXANDER MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF UROLOGY, SHREVEPORT, LA 71103-4228
(318) 813-2750
(318) 813-2755
Mailing address
1501 KINGS HWY, DEPARTMENT OF UROLOGY, SHREVEPORT, LA 71103-4228
(318) 813-2750
(318) 813-2755
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
07036R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1359629
—
LA
Enumeration date
07/17/2006
Last updated
08/20/2009
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