Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 1449899922 | UT |
Y | 213EG0000X | General Practice | 1449899922 | UT |
NPI | 1003034976 |
---|---|
Provider Name | Dr. Keith S Mattinson |
First Address | Payson, UT 84651-1667 |
Second Address | Payson, UT 84651-1667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |