Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 3833 | AZ |
Y | 207Q00000X | Family Doctor | 3833 | AZ |
NPI | 1184695371 |
---|---|
Provider Name | Dr. Vafa Matin |
First Address | Scottsdale, AZ 85254-3556 |
Second Address | Scottsdale, AZ 85254-3556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 10/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
834095 | (05) | AZ |
I04308 | (02) |