Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 21607 | AL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 21607 | AL |
NPI | 1225036569 |
---|---|
Provider Name | Dr. Daniel E. Matthews |
First Address | Daphne, AL 36526-0478 |
Second Address | Daphne, AL 36526-4728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 10/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000076575 | (05) | AL |
528700580 | GROUP MEDICAID (01) | AL |
G64970 | (02) |