Healthcare Provider Details

I. General information

NPI: 1053982454
Provider Name (Legal Business Name): MATTHEW TURNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48TH MDG, UNIT 5115
APO, AE AE
09461
GB

IV. Provider business mailing address

48TH MDG, UNIT 5115
APO, AE AE
09461
GB

V. Phone/Fax

Practice location:
  • Phone: 163-852-8010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35641
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: