Individual
MR. MATTHEW IVANYISKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
16777 MEDICAL CENTER DR, BATON ROUGE, LA 70816-3254
(225) 761-5200
Mailing address
PO BOX 471, ALBANY, LA 70711-0471
(225) 229-6288
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
310189
LA
Other
Enumeration date
10/23/2018
Last updated
10/23/2018
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