Provider Demographics
NPI:1891717310
Name:CARR, MATTHEW QUINN (DPM)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:QUINN
Last Name:CARR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 S 200 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2402
Mailing Address - Country:US
Mailing Address - Phone:801-463-2500
Mailing Address - Fax:801-486-2380
Practice Address - Street 1:1970 S 200 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2402
Practice Address - Country:US
Practice Address - Phone:801-463-2500
Practice Address - Fax:801-486-2380
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT377983-0501213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU70909Medicare UPIN