Doctor Name: | DR. IAN SIDNEY MATTHEWS |
NPI Number: | 1962844779 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | UO3736 |
Business Practice Address: | 206 2nd St E Bradenton, FL - 342081042 |
Business Phone Number: | 9133063126 |
Business Fax Number: | |
Mailing Address: | 511 N Chindit Blvd, Bldg 300 CANNON AFB |
State: | NM |
Postal Code: | 881035109 |
Phone Number: | 9133063126 |
Fax Number: | |
NPI Enumeration Date: | 07/22/2013 |
NPI Last Update Date: | 07/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | UO3736 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |