Provider Demographics
NPI:1386676757
Name:STRUTTMANN, MATTHEW G (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:STRUTTMANN
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 1:210 PORTLAND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6677
Mailing Address - Country:US
Mailing Address - Phone:573-777-8818
Mailing Address - Fax:573-777-8819
Practice Address - Street 1:210 PORTLAND ST STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6677
Practice Address - Country:US
Practice Address - Phone:573-777-8818
Practice Address - Fax:573-777-8819
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-90795207RG0100X
MO2006013858207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicaid
PENDINGMedicare ID - Type Unspecified
MOPENDINGMedicaid