Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | N5280 | TX |
Y | 207XS0106X | Orthopaedic Hand Surgeon | N5280 | TX |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | N5280 | TX |
N | 207XX0801X | Orthopaedic Trauma Surgeon | N5280 | TX |
NPI | 1407075617 |
---|---|
Provider Name | Dr. Matthew Nevitt |
First Address | Dallas, TX 75246-1615 |
Second Address | Dallas, TX 75246-1615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 02/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1407075617 | NPI (01) | |
295027101 | (05) | TX |
295027102 | (05) | TX |
8AD836 | BCBS PAR (01) | TX |
N5280 | TEXAS MEDICAL LICENSE (01) | TX |