MEDICARE: MATTHEW BEZZANT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	522	WY

General Provider Information

NPI Number	:	1578873774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW BEZZANT PA-C

Provider Business Mailing Address
First Line	:	2970 N MAIN ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1152
Country	:	US
Telephone Number	:	575-525-3531
Fax Number	:	575-525-3534

Provider Business Practice Location Address
First Line	:	2970 N MAIN ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1152
Country	:	US
Telephone Number	:	575-525-3531
Fax Number	:	575-525-3534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	09/08/2020

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Directions to “ MATTHEW BEZZANT PA-C” Practice Location

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