Provider Demographics
NPI:1326447798
Name:MATSHES, EVAN (MD FRCPC)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:MATSHES
Suffix:
Gender:M
Credentials:MD FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 UPTOWN LOOP NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6029
Mailing Address - Country:US
Mailing Address - Phone:530-574-9219
Mailing Address - Fax:
Practice Address - Street 1:2222 UPTOWN LOOP NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6029
Practice Address - Country:US
Practice Address - Phone:530-574-9219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0177171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor