Provider Demographics
NPI:1770698722
Name:CONKLIN, MATTHEW M (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:M
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 29870
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9870
Mailing Address - Country:US
Mailing Address - Phone:602-772-3800
Mailing Address - Fax:602-772-3801
Practice Address - Street 1:690 N COFCO CENTER CT
Practice Address - Street 2:SUITE 270
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6462
Practice Address - Country:US
Practice Address - Phone:602-393-1010
Practice Address - Fax:602-393-1011
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23552207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3Z3952OtherHEALTHNET
AZ321745Medicaid
AZ3Z3952OtherHEALTHNET
AZ321745Medicaid