Provider Demographics
NPI:1710268818
Name:SCHEBERLE, MATTHEW ANTHONY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ANTHONY
Last Name:SCHEBERLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WINDWALKER RD
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-8507
Mailing Address - Country:US
Mailing Address - Phone:970-689-9977
Mailing Address - Fax:
Practice Address - Street 1:910 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4226
Practice Address - Country:US
Practice Address - Phone:970-249-6641
Practice Address - Fax:970-249-5148
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3182363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant