Provider Demographics
NPI:1447773536
Name:BLUNDEN, MATTHEW THOMAS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:BLUNDEN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1031 SUNCREST DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1136
Mailing Address - Country:US
Mailing Address - Phone:810-245-6111
Mailing Address - Fax:810-538-1597
Practice Address - Street 1:1031 SUNCREST DRIVE
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1136
Practice Address - Country:US
Practice Address - Phone:810-245-6111
Practice Address - Fax:810-245-6111
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2017-10-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical