NPI 1003558594
Matthew Disedare
Practice location
- Address
- 1418 Tiger Dr, Thibodaux, LA 70301-4337
- Phone
- (985) 449-4055
- Fax
- (985) 449-4178
Registered specialties
Case Manager/Care Coordinator
Primary
Registry record
- NPI
- 1003558594
- Entity type
- Individual
- Sex (as registered)
- Male
- NPI issued
- 13 Apr 2022
- Record last updated
- 13 Apr 2022
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.