Provider Demographics
NPI:1720048853
Name:MATTHEWS, ROBERT CECIL II (CST/CFA/KCSA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CECIL
Last Name:MATTHEWS
Suffix:II
Gender:M
Credentials:CST/CFA/KCSA
Other - Prefix:MR
Other - First Name:R.
Other - Middle Name:MATT
Other - Last Name:MATTHEWS
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:CST/CFA/KCSA
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-0264
Mailing Address - Country:US
Mailing Address - Phone:520-905-1293
Mailing Address - Fax:
Practice Address - Street 1:545 AUTUMN GLEN DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-0264
Practice Address - Country:US
Practice Address - Phone:520-905-1293
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY93050246ZS0410X
KYSA106246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist