Provider Demographics
NPI:1548257363
Name:MATEWERE, GEORGE G (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:G
Last Name:MATEWERE
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 1:1790 SATURN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-2270
Mailing Address - Country:US
Mailing Address - Phone:504-253-4674
Mailing Address - Fax:504-253-4717
Practice Address - Street 1:1790 SATURN DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2270
Practice Address - Country:US
Practice Address - Phone:504-253-4674
Practice Address - Fax:504-253-4717
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1533807Medicaid
TX1533807Medicaid
TX8D5108Medicare ID - Type Unspecified