Provider Demographics
NPI:1265482251
Name:PULEO, MATTHEW B (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:B
Last Name:PULEO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2222 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4872
Mailing Address - Country:US
Mailing Address - Phone:602-277-6211
Mailing Address - Fax:866-242-5309
Practice Address - Street 1:2222 E HIGHLAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4872
Practice Address - Country:US
Practice Address - Phone:602-277-6211
Practice Address - Fax:866-242-5309
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2923363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ093164Medicaid
AZ2923OtherLICENSE #
AZQ12016Medicare UPIN
AZ093164Medicaid