Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 01060903A | IN |
N | 2080P0208X | Pediatric Infectious Diseases | 01060903A | IN |
NPI | 1346431905 |
---|---|
Provider Name | Dr. Matthew Daniel Eberly SR. |
First Address | Washington, DC 20307-0001 |
Second Address | Jbsa Ft Sam Houston, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 12/08/2021 |