Provider Demographics
NPI:1770894842
Name:MATTHEW, VALERIE (MD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:MATTHEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-838-8265
Mailing Address - Fax:
Practice Address - Street 1:1669 W INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1982
Practice Address - Country:US
Practice Address - Phone:520-448-0660
Practice Address - Fax:520-784-7226
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51064207Q00000X, 207Q00000X
AZR73210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLL2472OtherRESIDENT LICENSE
AZ51064OtherAZ LICENSE
AZR73210OtherRESIDENT PERMIT