Doctor Name: | MR. MATT P. PREWITT |
NPI Number: | 1023044898 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A.-C |
License Number: | 98-PA17 |
Business Practice Address: | 2201 S Clear Creek Rd Killeen, TX - 765494110 |
Business Phone Number: | 2545198871 |
Business Fax Number: | |
Mailing Address: | 100 High Trail Dr, GEORGETOWN |
State: | TX |
Postal Code: | 786334582 |
Phone Number: | 5757701530 |
Fax Number: | |
NPI Enumeration Date: | 06/24/2006 |
NPI Last Update Date: | 04/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 98-PA17 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NM |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |