Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0200X | Radiology | POD000987 | GA |
N | 213ER0200X | Radiology | POD000987 | GA |
Y | 213ES0103X | Foot & Ankle Surgery | POD000987 | GA |
NPI | 1083696090 |
---|---|
Provider Name | Dr. Matthew C D Eller |
First Address | Brunswick, GA 31520-4265 |
Second Address | Brunswick, GA 31520-4265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 22/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V00227 | (02) | GA |