MEDICARE: MATTHEW TAMPLEN M.D.

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	207Y00000X	Otolaryngology Physician	ME130782	FL
2	207YS0123X	Facial Plastic Surgery Physician	64664	AZ
3	207Y00000X	Otolaryngology Physician	64664	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	YD6TC	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1801148242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW TAMPLEN M.D.

Provider Business Mailing Address
First Line	:	4530 E SHEA BLVD STE 180
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-6042
Country	:	US
Telephone Number	:	602-264-4834
Fax Number	:	602-254-5178

Provider Business Practice Location Address
First Line	:	77 MORAGA WAY STE G
Second Line	:
City	:	ORINDA
State	:	CA
Zip	:	94563-3019
Country	:	US
Telephone Number	:	925-444-0824
Fax Number	:

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

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	11/28/2022

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