Provider Demographics
NPI:1245496900
Name:WETZEL, MATTHEW SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SCOTT
Last Name:WETZEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4777 US HIGHWAY 259
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7668
Mailing Address - Country:US
Mailing Address - Phone:903-663-7393
Mailing Address - Fax:903-663-7394
Practice Address - Street 1:1101 26TH STREET SOUTH
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-731-8401
Practice Address - Fax:903-663-7394
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MT320582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program