Provider Demographics
NPI:1083819908
Name:NUGENT, MATTHEW T (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:T
Last Name:NUGENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2780 E BARNETT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8674
Mailing Address - Country:US
Mailing Address - Phone:541-779-6250
Mailing Address - Fax:541-608-2535
Practice Address - Street 1:702 SW RAMSEY AVE STE 112
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5859
Practice Address - Country:US
Practice Address - Phone:541-472-0603
Practice Address - Fax:541-472-0609
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD158575207X00000X, 207X00000X
SC34484207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery