Healthcare Provider Details

I. General information

NPI: 1922261304
Provider Name (Legal Business Name): DWIGHT M MATTHEW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 E DR HICKS BLVD STE A
FLORENCE AL
35630-5707
US

IV. Provider business mailing address

422 E DR HICKS BLVD STE A
FLORENCE AL
35630-5707
US

V. Phone/Fax

Practice location:
  • Phone: 256-766-1401
  • Fax: 256-766-1402
Mailing address:
  • Phone: 256-766-1401
  • Fax: 256-766-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31604
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number31604
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: