Provider Demographics
NPI:1720354467
Name:CHRISTIE, MATTHEW AARON (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 W CHARLESTON BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0083
Mailing Address - Country:US
Mailing Address - Phone:702-671-5127
Mailing Address - Fax:
Practice Address - Street 1:4029 DEAN MARTIN DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4138
Practice Address - Country:US
Practice Address - Phone:702-848-2256
Practice Address - Fax:702-485-6746
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NVSL14502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1720354467Medicaid