Provider Demographics
NPI:1750720447
Name:DUER, MATTHEW KURTIS (AA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:KURTIS
Last Name:DUER
Suffix:
Gender:M
Credentials:AA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7660 WOODVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:SAINT PARIS
Mailing Address - State:OH
Mailing Address - Zip Code:43072-9317
Mailing Address - Country:US
Mailing Address - Phone:937-362-2660
Mailing Address - Fax:
Practice Address - Street 1:100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-1312
Practice Address - Country:US
Practice Address - Phone:877-708-9753
Practice Address - Fax:937-521-3910
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67000217367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant