Provider Demographics
NPI:1487199287
Name:PAVELEK, MATTHEW JOSEPH (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:PAVELEK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 N 44TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7227
Mailing Address - Country:US
Mailing Address - Phone:602-393-1010
Mailing Address - Fax:602-393-1011
Practice Address - Street 1:3033 N 44TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7227
Practice Address - Country:US
Practice Address - Phone:602-393-1010
Practice Address - Fax:602-393-1011
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6899363A00000X
TXPA10755207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6899OtherARIZONA STATE LICENSE