Healthcare Provider Details

I. General information

NPI: 1457275158
Provider Name (Legal Business Name): MATTHEW HEMM PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E FLORENCE BLVD
CASA GRANDE AZ
85122-5303
US

IV. Provider business mailing address

6881 SAN DIEGO DR
BUENA PARK CA
90620-2909
US

V. Phone/Fax

Practice location:
  • Phone: 520-381-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12021
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: