Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 11368809-1204 | UT |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | OS13354 | FL |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | UO3788 | FL |
NPI | 1043644040 |
---|---|
Provider Name | Dr. Matthew Irvin |
First Address | Provo, UT 84604 |
Second Address | South Miami, FL 33143-4701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2013 |
Last Update Date | 10/08/2020 |