Provider Demographics
NPI: | 1508804782 |
---|---|
Name: | MATTHES, JEFFREY DAVID (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JEFFREY |
Middle Name: | DAVID |
Last Name: | MATTHES |
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: | PO BOX 7239 |
Mailing Address - Street 2: | |
Mailing Address - City: | LOVELAND |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80537-0239 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 402-489-9400 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1400 DOWELL SPRINGS BLVD STE 200 |
Practice Address - Street 2: | |
Practice Address - City: | KNOXVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37909-2457 |
Practice Address - Country: | US |
Practice Address - Phone: | 865-584-0291 |
Practice Address - Fax: | 865-584-4426 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-02 |
Last Update Date: | 2023-09-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 63689 | 2085R0202X |
NE | 17529 | 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KS | 100146450A | Medicaid | |
SD | 7787070 | Medicaid | |
IA | 0521013 | Medicaid | |
NE | 300029831 | Other | RR MEDICARE |
TN | Q072920 | Medicaid | |
IA | 0521013 | Medicaid | |
F25028 | Medicare UPIN |