Provider Demographics
NPI:1154616936
Name:NAUTS, MATIAS JAVIER (DO)
Entity type:Individual
Prefix:DR
First Name:MATIAS
Middle Name:JAVIER
Last Name:NAUTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-2609
Practice Address - Street 1:401 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:SUITE 100 C&D
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5864
Practice Address - Country:US
Practice Address - Phone:337-430-3150
Practice Address - Fax:337-430-3158
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LADO.000459208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2399837Medicaid
LA438484YJBAMedicare PIN