Provider Demographics
NPI:1215070115
Name:MAUTERER, ARTHUR A (MD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:A
Last Name:MAUTERER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WALNUT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-2055
Mailing Address - Country:US
Mailing Address - Phone:985-748-5004
Mailing Address - Fax:985-748-7003
Practice Address - Street 1:309 WALNUT ST
Practice Address - Street 2:SUITE B
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2055
Practice Address - Country:US
Practice Address - Phone:985-748-5004
Practice Address - Fax:985-748-7003
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008117207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1037214Medicaid
LAB64436Medicare UPIN
LA53187Medicare ID - Type Unspecified