Provider Demographics
NPI:1114171733
Name:ANDERSON, MATTHEW J (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W. THOMAS ROAD, SUITE 850
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013
Mailing Address - Country:US
Mailing Address - Phone:602-406-2665
Mailing Address - Fax:602-212-4768
Practice Address - Street 1:500 W. THOMAS ROAD, SUITE 850
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:602-406-2669
Practice Address - Fax:602-406-6889
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4337363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant