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1912699547
MATTHEW QUINN EZERNACK
LAKE CHARLES, LA
NPI
1912699547
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
208100000X Physical Medicine & Rehabilitation
(Licence: LA 11530)
Enumeration Date
2023-05-23
Last Update Date
2023-05-23
Business Address
MATTHEW QUINN EZERNACK
4080 NELSON RD STE 500
LAKE CHARLES, LA 70605-2440
Phone number: 337-494-7546
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Mailing Address
MATTHEW QUINN EZERNACK
2923 SUMMER PLACE DR
SULPHUR, LA 70663-0758
Phone number: 337-309-0925
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