Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4744 | AZ |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 4744 | AZ |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 4744 | AZ |
NPI | 1013123058 |
---|---|
Provider Name | Matthew Thomas Weichbrodt |
First Address | Phoenix, AZ 85023-1266 |
Second Address | Sun City, AZ 85351-3058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 24/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
321626 | (05) | AZ |
5550830001 | MEDICARE NSC SCW (01) | AZ |
5550830003 | MEDICARE NSC PEORIA (01) | AZ |
5550830004 | MEDICARE NSC PV (01) | AZ |
5550830006 | MEDICARE NSC ANTHEM (01) | AZ |
5550830007 | MEDICARE NSC DV (01) | AZ |
5550830008 | MEDICARE NSC SWV (01) | AZ |
5550830009 | MEDICARE NSC AZ NORTH (01) | AZ |
5550830010 | MEDICARE NSC GILBERT (01) | AZ |
P00688674 | RR MEDICARE (01) | AZ |