Provider Demographics
NPI:1639117435
Name:MATSON, THOMAS C (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:MATSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN378222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34395400Medicaid
MN850072OtherAMERICA'S PPO
MN077723400Medicaid
IA1546184Medicaid
MN300134720OtherRAILROAD MEDICARE MN
MN65G45MAOtherBLUE CROSS
MNHP34233OtherHEALTHPARTNERS
MN1602173OtherMEDICA
MN1016283OtherPREFERRED ONE
MN125236OtherUCARE
MN299G3MAOtherBLUE CROSS
WI003356135Medicare PIN
MN300134720OtherRAILROAD MEDICARE MN
MN1016283OtherPREFERRED ONE
MNHP34233OtherHEALTHPARTNERS
MN65G45MAOtherBLUE CROSS