Provider Demographics
NPI:1679773600
Name:HASTINGS, MATTHEW MOSER (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MOSER
Last Name:HASTINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3 MARYLAND FARMS STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5780
Mailing Address - Country:US
Mailing Address - Phone:800-348-4565
Mailing Address - Fax:888-203-4247
Practice Address - Street 1:5641 FAIRWAY RD
Practice Address - Street 2:
Practice Address - City:FAIRWAY
Practice Address - State:KS
Practice Address - Zip Code:66205-2643
Practice Address - Country:US
Practice Address - Phone:800-348-4565
Practice Address - Fax:888-203-4247
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20130174312084N0400X
FLME1488682084N0400X
NMMD2021-01912084N0400X
KS04366532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2314009Medicare PIN
MOMA3554016Medicare PIN