| Organization Name: | KENNETH P. MAUTERER MD A MEDICAL CORP |
| NPI Number: | 1205018017 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENNETH P MAUTERER (PRESIDENT) |
| Mailing Address: | 1148 N Pine Road Olla |
| State: | LA US |
| Postal Code: | 71465 |
| Phone Number: | 3184953131 |
| Fax Number: | 3184953677 |
| NPI Enumeration Date: | 12/04/2007 |
| NPI Last Update Date: | 12/04/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 012667 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |