Provider Demographics
NPI:1902891633
Name:REHMAN, MATLOOB UR (MD)
Entity Type:Individual
Prefix:
First Name:MATLOOB
Middle Name:UR
Last Name:REHMAN
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 1:1310 ANDORRA LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4545
Mailing Address - Country:US
Mailing Address - Phone:985-809-6963
Mailing Address - Fax:985-876-1489
Practice Address - Street 1:52579 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:LA
Practice Address - Zip Code:70443-2231
Practice Address - Country:US
Practice Address - Phone:985-878-9421
Practice Address - Fax:985-878-1285
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD199980207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1476421Medicaid
MS00124874Medicaid
MS302I117857Medicare PIN
MS00124874Medicaid
MS302I112446Medicare PIN
H34427Medicare UPIN