Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 02003308A | IN |
Y | 207L00000X | Anesthesiologist | 87823 | MT |
NPI | 1013087873 |
---|---|
Provider Name | Dr. Andrew Keith Matthies |
First Address | Eglin Afb, FL 32542-1302 |
Second Address | Eglin Afb, FL 32542-1302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 15/06/2020 |