Provider Demographics
NPI:1780023838
Name:ALLRED, MATTHEW HARDY (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:HARDY
Last Name:ALLRED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 MADISON PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2057
Mailing Address - Country:US
Mailing Address - Phone:208-356-6185
Mailing Address - Fax:208-356-0378
Practice Address - Street 1:15 MADISON PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-2057
Practice Address - Country:US
Practice Address - Phone:208-356-6185
Practice Address - Fax:208-356-0378
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2013020281207V00000X
IDO-1026207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty