Provider Demographics
NPI:1548217268
Name:STAYMAN, MATHEW LLOYD (MD)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:LLOYD
Last Name:STAYMAN
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 1:929 CENTRAL AVE NW
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-1917
Mailing Address - Country:US
Mailing Address - Phone:218-773-6800
Mailing Address - Fax:
Practice Address - Street 1:929 CENTRAL AVE NW
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1917
Practice Address - Country:US
Practice Address - Phone:218-773-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8225207Q00000X
MN44098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND26485OtherBCBS
ND10952Medicaid
MN500M3STOtherBCBS
HP34258OtherHEALTHPARTNERS
0123580OtherMEDICA
MN991483800Medicaid
NA4571028643OtherPREFERRED ONE
MN500M3STOtherBCBS
HP34258OtherHEALTHPARTNERS
MN080016310Medicare PIN
ND26485OtherBCBS
G94179Medicare UPIN
NDN711956Medicare ID - Type Unspecified
MN080173928Medicare PIN