Provider Demographics
NPI:1003582842
Name:BROSS, MATTHEW CADE (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CADE
Last Name:BROSS
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Gender:
Credentials:PA-C
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Mailing Address - Street 1:6800 NW 39TH EXPY
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-2513
Mailing Address - Country:US
Mailing Address - Phone:405-789-6711
Mailing Address - Fax:405-349-5145
Practice Address - Street 1:6800 NW 39TH EXPY
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2513
Practice Address - Country:US
Practice Address - Phone:405-789-6711
Practice Address - Fax:405-349-5145
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2025-02-28
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Provider Licenses
StateLicense IDTaxonomies
OK4979363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant