Healthcare Provider Details

I. General information

NPI: 1407218860
Provider Name (Legal Business Name): MATTHEW JORDAN STEELE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 N 10TH ST STE B
PHOENIX AZ
85006
US

IV. Provider business mailing address

5601 W EUGIE AVE STE 100
GLENDALE AZ
85304-1256
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-7285
  • Fax: 602-406-7186
Mailing address:
  • Phone: 209-996-8807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number007411
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: