Provider Demographics
NPI:1891750766
Name:OFFERDAHL, MATTHEW ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
Last Name:OFFERDAHL
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 1:2810 N SWAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6305
Mailing Address - Country:US
Mailing Address - Phone:520-324-2030
Mailing Address - Fax:520-324-2619
Practice Address - Street 1:2810 N SWAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6305
Practice Address - Country:US
Practice Address - Phone:520-324-2030
Practice Address - Fax:520-324-2619
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33805207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ950594Medicaid
104708Medicare ID - Type Unspecified
AZ950594Medicaid