Provider Demographics
NPI:1245733500
Name:SEARS, MATTHEW CHRISTOPHER (SFIDC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHRISTOPHER
Last Name:SEARS
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:CHRISTOPHER
Other - Last Name:SEARS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SFIDC
Mailing Address - Street 1:10168 KEPPLER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2504
Mailing Address - Country:US
Mailing Address - Phone:937-367-2042
Mailing Address - Fax:
Practice Address - Street 1:34101 FARENHOLT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-7000
Practice Address - Country:US
Practice Address - Phone:937-367-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman