Provider Demographics
NPI:1346245180
Name:FOLEY, MATTHEW V (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:V
Last Name:FOLEY
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 1:2345 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609
Mailing Address - Country:US
Mailing Address - Phone:307-689-6109
Mailing Address - Fax:
Practice Address - Street 1:2345 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2037
Practice Address - Country:US
Practice Address - Phone:307-689-6109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34225207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY314258OtherBLUE SHEILD
KY64016090Medicaid
WYP00361983OtherRAILROAD MEDICARE
0336324Medicare ID - Type Unspecified
KY64016090Medicaid
WYW20979Medicare PIN