Provider Demographics
NPI:1477934636
Name:HUCKABEE, MATTHEW MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MARK
Last Name:HUCKABEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3760 PIPER ST STE 1108
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4683
Mailing Address - Country:US
Mailing Address - Phone:907-212-6900
Mailing Address - Fax:907-212-6936
Practice Address - Street 1:3760 PIPER ST STE 1108
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-212-6900
Practice Address - Fax:907-212-6936
Is Sole Proprietor?:No
Enumeration Date:2015-06-14
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI51010219122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315071262OtherCONTROLLED SUBSTANCE LICENSE
MI5101021912OtherEDUCATIONAL LIMITED LICENSE