Provider Demographics
NPI:1205945482
Name:MATANKY, BRYAN K (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:K
Last Name:MATANKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1760 E FLORENCE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-4764
Mailing Address - Country:US
Mailing Address - Phone:520-426-1000
Mailing Address - Fax:520-426-1395
Practice Address - Street 1:1760 E FLORENCE BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4764
Practice Address - Country:US
Practice Address - Phone:520-426-1000
Practice Address - Fax:520-426-1395
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ22110207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ200018286OtherRR MEDICARE
AZF66298OtherMERCY HEALTH PLANS
AZ0046722OtherDEPT. LABOR
AZ1Z1375OtherHEALTHNET
AZ86-0754243OtherIRS TAX ID
AZ15781901Medicaid
AZAZ0351140OtherBC/BS
AZ200018286OtherRR MEDICARE
F66298Medicare UPIN