Provider Demographics
NPI:1518959733
Name:OLLERTON, MATTHEW G (DPM)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:G
Last Name:OLLERTON
Suffix:
Gender:M
Credentials:DPM
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 595
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-0595
Mailing Address - Country:US
Mailing Address - Phone:801-491-3668
Mailing Address - Fax:801-489-6378
Practice Address - Street 1:5 E 400 N
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1347
Practice Address - Country:US
Practice Address - Phone:801-491-3668
Practice Address - Fax:801-489-6378
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT370042-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT370042-8907OtherSTATE CONTROLLED SUBSTANC
AZ909244Medicaid
UT370042-0501OtherSTATE LICENSE
UT4321250001OtherFEDERAL DME #
UT4321250001OtherFEDERAL DME #
UT005819105Medicare PIN
UT370042-0501OtherSTATE LICENSE
UT000012215Medicare PIN