Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | D85499 | MD |
N | 207QS0010X | Family Doctor - Sports Medicine | 40570 | SC |
N | 207QS0010X | Family Doctor - Sports Medicine | D85499 | MD |
NPI | 1174968077 |
---|---|
Provider Name | Matthew James Jepson |
First Address | Frederick, MD 21702-4348 |
Second Address | Frederick, MD 21702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2013 |
Last Update Date | 14/06/2020 |