Healthcare Provider Details

I. General information

NPI: 1962486027
Provider Name (Legal Business Name): MATTHEW CARL JEPSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATTHEW C JEPSEN MD

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10503 W THUNDERBIRD BLVD STE 104
SUN CITY AZ
85351-3047
US

IV. Provider business mailing address

14510 W SHUMWAY DR STE 101
SUN CITY WEST AZ
85375-5815
US

V. Phone/Fax

Practice location:
  • Phone: 623-975-1660
  • Fax: 623-584-4282
Mailing address:
  • Phone: 623-975-1660
  • Fax: 623-584-4282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number76971
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME149465
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number78872-8905
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number46765
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: