Individual
JOSE A MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2309 E MAIN ST, STE 400, NEW IBERIA, LA 70560-4046
(337) 367-0271
(337) 364-6139
Mailing address
2309 E MAIN ST, STE 400, NEW IBERIA, LA 70560-4046
(337) 367-0271
(337) 364-6139
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
015812
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1333093
—
LA
Enumeration date
07/21/2005
Last updated
12/23/2014
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