Individual
DWIGHT D. MATHERNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
144 W 134TH ST, CUT OFF, LA 70345-4155
(985) 632-6233
(985) 632-7526
Mailing address
144 W 134TH ST, CUT OFF, LA 70345-4155
(985) 632-6233
(985) 632-7526
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.A10369.RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1625957
—
LA
Enumeration date
06/06/2006
Last updated
03/22/2023
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