Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | AU5009697-1056 | MS |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 2011W244 | MS |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 47283 | TN |
NPI | 1124221601 |
---|---|
Provider Name | Matthew Cassedy Futvoye |
First Address | Charlotte, NC 28230-0594 |
Second Address | Flowood, MS 39232-6621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 08/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09481205 | (05) | MS |