Provider Demographics
NPI:1588627855
Name:PRIDE, MATTHEW BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BARRY
Last Name:PRIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3317 CHANATE RD
Mailing Address - Street 2:STE 2C
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404
Mailing Address - Country:US
Mailing Address - Phone:707-570-1130
Mailing Address - Fax:707-526-1572
Practice Address - Street 1:3317 CHANATE RD
Practice Address - Street 2:STE 2C
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-570-1130
Practice Address - Fax:707-526-1572
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78085207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG780850Medicaid
G66606Medicare UPIN
CAOOG780850Medicaid