Provider Demographics
NPI:1790745271
Name:FEIL, MATTHEW E (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:FEIL
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 1:144 S 500 E
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1907
Mailing Address - Country:US
Mailing Address - Phone:801-463-7415
Mailing Address - Fax:
Practice Address - Street 1:3460 PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2049
Practice Address - Country:US
Practice Address - Phone:801-964-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5858730-1204207PE0004X, 207PE0005X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTB002OtherTRICARE
UT100638OtherPEHP
UT58587031200001OtherBC/BS
UT58587301204001OtherBC/BS
UT58587301202001OtherBC/BS
UTP00252694OtherRAILROAD MEDICARE
UT58587301205001OtherBC/BS
UT58587301206001OtherBC/BS
UT58587301201001OtherBC/BS
UT58587301203001OtherBC/BS
UTD6098Medicaid
UT58587301203001OtherBC/BS
UTI18024Medicare UPIN
UT005567235Medicare PIN
UT005568637Medicare PIN
UT58587301204001OtherBC/BS
UTD6098Medicaid
UT005568351Medicare PIN
UTB002OtherTRICARE
UTP00252694OtherRAILROAD MEDICARE