Healthcare Provider Details

I. General information

NPI: 1013123058
Provider Name (Legal Business Name): MATTHEW THOMAS WEICHBRODT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10484 W THUNDERBIRD BLVD STE 100
SUN CITY AZ
85351-6019
US

IV. Provider business mailing address

18444 N 25TH AVE STE 310
PHOENIX AZ
85023-1266
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-5600
  • Fax: 866-939-2673
Mailing address:
  • Phone: 623-537-5600
  • Fax: 866-939-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4744
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number4744
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number4744
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: