Provider Demographics
NPI:1225036569
Name:MATTHEWS, DANIEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-0478
Mailing Address - Country:US
Mailing Address - Phone:251-491-2676
Mailing Address - Fax:251-491-2685
Practice Address - Street 1:6401 JORDAN RD
Practice Address - Street 2:SUITE A
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4728
Practice Address - Country:US
Practice Address - Phone:251-491-2676
Practice Address - Fax:251-491-2685
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21607207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528700580OtherGROUP MEDICAID
AL000076575Medicaid
AL000076575Medicaid