Provider Demographics
NPI:1629568738
Name:PRIEBE, MATTHEW MYRON (MSOM)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:MYRON
Last Name:PRIEBE
Suffix:
Gender:M
Credentials:MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2555 PHILLIPS FIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3933
Mailing Address - Country:US
Mailing Address - Phone:907-328-2920
Mailing Address - Fax:907-313-2887
Practice Address - Street 1:2555 PHILLIPS FIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3933
Practice Address - Country:US
Practice Address - Phone:907-328-2920
Practice Address - Fax:907-313-2887
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK132650171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist