Provider Demographics
NPI:1700988730
Name:ALLISON, MATTHEW A (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:ALLISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9500 GILMAN DR
Mailing Address - Street 2:MAILCODE 0965
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0965
Mailing Address - Country:US
Mailing Address - Phone:858-642-3289
Mailing Address - Fax:858-822-7662
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:MAILCODE 112V
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-642-3289
Practice Address - Fax:858-822-7662
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2015-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG0800542083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH50083Medicare UPIN
CAWG80054AMedicare ID - Type Unspecified