Healthcare Provider Details

I. General information

NPI: 1801148242
Provider Name (Legal Business Name): MATTHEW TAMPLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MORAGA WAY STE G
ORINDA CA
94563-3019
US

IV. Provider business mailing address

4530 E SHEA BLVD STE 180
PHOENIX AZ
85028-6042
US

V. Phone/Fax

Practice location:
  • Phone: 925-444-0824
  • Fax:
Mailing address:
  • Phone: 602-264-4834
  • Fax: 602-254-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME130782
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number64664
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number64664
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: