Healthcare Provider Details

I. General information

NPI: 1770698722
Provider Name (Legal Business Name): MATTHEW M CONKLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 N COFCO CENTER CT SUITE 270
PHOENIX AZ
85008-6462
US

IV. Provider business mailing address

P.O. BOX 29870
PHOENIX AZ
85038-9870
US

V. Phone/Fax

Practice location:
  • Phone: 602-393-1010
  • Fax: 602-393-1011
Mailing address:
  • Phone: 602-772-3800
  • Fax: 602-772-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number23552
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: