Provider Demographics
NPI:1891835872
Name:DEVRIES, MATTHEW JARED (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JARED
Last Name:DEVRIES
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 1:301 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-3380
Mailing Address - Country:US
Mailing Address - Phone:402-344-3699
Mailing Address - Fax:
Practice Address - Street 1:981045 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-1045
Practice Address - Country:US
Practice Address - Phone:402-559-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE237152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology