Provider Demographics
NPI:1689712077
Name:MATSUYAMA, DUKE TSUKASA (DO)
Entity Type:Individual
Prefix:DR
First Name:DUKE
Middle Name:TSUKASA
Last Name:MATSUYAMA
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 1:152 WESTWICK LN
Mailing Address - Street 2:APT. 2
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2737
Mailing Address - Country:US
Mailing Address - Phone:937-684-1007
Mailing Address - Fax:
Practice Address - Street 1:957 OLD MCPHERSON CHURCH RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5382
Practice Address - Country:US
Practice Address - Phone:910-323-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401415207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology