Healthcare Provider Details

I. General information

NPI: 1932593274
Provider Name (Legal Business Name): MATTHEW ERIC WINGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-8258
  • Fax: 949-764-4559
Mailing address:
  • Phone: 949-764-8258
  • Fax: 949-764-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA176485
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD226373
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA176485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: