Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | E-11842 | AR |
N | 2080P0214X | Pediatric Pulmonologist | ME127219 | FL |
NPI | 1194161869 |
---|---|
Provider Name | Matthew Christopher Pertzborn |
First Address | Little Rock, AR 72202-3591 |
Second Address | Little Rock, AR 72202-3591 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2013 |
Last Update Date | 01/07/2019 |