Provider Demographics
NPI:1568755734
Name:SELLECK, MATTHEW JORDAN (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JORDAN
Last Name:SELLECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 N TENAYA WAY STE 510
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0448
Mailing Address - Country:US
Mailing Address - Phone:702-962-2300
Mailing Address - Fax:
Practice Address - Street 1:3150 N TENAYA WAY STE 510
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0448
Practice Address - Country:US
Practice Address - Phone:702-962-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-22
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12468208600000X
NVDO28592086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery