MATTHEW BRYAN MASTRODOMENICO

SHREVEPORT, LA
NPI1487944930
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology
(Licence: LA  MD.301728)
Additional Taxonomies207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology
(Licence: SC  MD37690)
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2011-04-17
Last Update Date2016-07-22
Business Address
-- MATTHEW BRYAN MASTRODOMENICO M.D.
2915 MISSOURI AVE
SHREVEPORT, LA 71109-4327
Phone number: 318-621-8820
Mailing Address
-- MATTHEW BRYAN MASTRODOMENICO M.D.
PO BOX 731280
DALLAS, TX 75373-1280
Phone number: 318-841-9526