Provider Demographics
NPI:1962279950
Name:ROHLER, MATTHEW JAMES (PA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:ROHLER
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:ROHLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-0617
Mailing Address - Country:US
Mailing Address - Phone:928-662-0406
Mailing Address - Fax:928-662-0407
Practice Address - Street 1:601 W RIVERSIDE DR STE 2
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5119
Practice Address - Country:US
Practice Address - Phone:928-256-4110
Practice Address - Fax:928-256-4112
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ10842363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program