Provider Demographics
NPI:1821251794
Name:MATCHIN, BRUCE LIRON (DOCTOR OF OSTEOPATHY)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LIRON
Last Name:MATCHIN
Suffix:
Gender:M
Credentials:DOCTOR OF OSTEOPATHY
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Mailing Address - Street 1:8901 WISCONSIN AVENUE
Mailing Address - Street 2:NNMC - GME BUILDING 10 1ST FLOOR ROOM 1006
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:20889-5600
Mailing Address - Country:US
Mailing Address - Phone:301-319-8278
Mailing Address - Fax:
Practice Address - Street 1:CAPTAIN JAMES A. LOVELL FEDERAL HEALTH CARE CENTER
Practice Address - Street 2:3001 GREEN BAY ROAD
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:847-688-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2021016045207QS0010X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program