Provider Demographics
NPI:1710989736
Name:MERMER, MATTHEW J (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:MERMER
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1600 EUREKA RD
Mailing Address - Street 2:ORTHOPAEDICS 2ND FLOOR
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-784-5268
Mailing Address - Fax:916-784-5194
Practice Address - Street 1:1600 EUREKA RD
Practice Address - Street 2:ORTHOPAEDICS 2ND FLOOR
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3027
Practice Address - Country:US
Practice Address - Phone:916-784-5268
Practice Address - Fax:916-784-5194
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71955207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI13730Medicare UPIN
CA00A719550Medicare PIN