Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301026169 | MI |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 30798 | AZ |
NPI | 1194986638 |
---|---|
Provider Name | Dr. Larry Stanford Matthews |
First Address | Ann Arbor, MI 48109-5328 |
Second Address | Ann Arbor, MI 48109-5328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 18/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1244726 | (05) | MI |
B4608901 | (02) | MI |