Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 13975 | AZ |
Y | 208600000X | Surgeon | 13975 | AZ |
N | 2086S0129X | Vascular Surgeon | 13975 | AZ |
NPI | 1023074945 |
---|---|
Provider Name | Dr. Charles Matlin |
First Address | Phoenix, AZ 85032-3356 |
Second Address | Phoenix, AZ 85021-8860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 03/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
260836 | (05) | AZ |
C99933 | (02) | AZ |