Provider Demographics
NPI:1750461661
Name:MATTHEWS, JOSEPH MOORE (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MOORE
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GOVERNORS LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:530-891-4523
Mailing Address - Fax:530-891-5934
Practice Address - Street 1:2 GOVERNORS LANE
Practice Address - Street 2:SUITE A
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-891-4523
Practice Address - Fax:530-891-5934
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32836208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA006328360Medicaid
CA020008276OtherMEDICARE RAILROAD #
A45311Medicare UPIN
A45311Medicare UPIN