Provider Demographics
NPI:1396063426
Name:MATTHEWS, TONY EDWARD JR
Entity type:Individual
Prefix:MR
First Name:TONY
Middle Name:EDWARD
Last Name:MATTHEWS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7380 COMITE DR
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-6058
Mailing Address - Country:US
Mailing Address - Phone:225-301-4601
Mailing Address - Fax:
Practice Address - Street 1:11406 SPRING STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722
Practice Address - Country:US
Practice Address - Phone:225-301-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider