Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 64664 | AZ |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ME130782 | FL |
N | 207YS0123X | Facial Plastic Surgeon | 64664 | AZ |
NPI | 1801148242 |
---|---|
Provider Name | Matthew Tamplen |
First Address | Phoenix, AZ 85028-6042 |
Second Address | Phoenix, AZ 85028-6042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2012 |
Last Update Date | 08/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021413300 | (05) | FL |
YD6TC | BLUE CROSS BLUE SHIELD (01) | FL |