Healthcare Provider Details

I. General information

NPI: 1013399005
Provider Name (Legal Business Name): MATTHEW HENRY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MDG UNIT 5115
APO AE
09461-5115
US

IV. Provider business mailing address

UNIT 5024
APO AP
96319-5024
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1580
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: