Healthcare Provider Details

I. General information

NPI: 1740835131
Provider Name (Legal Business Name): JACOB MATZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2019
Last Update Date: 08/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ORTHOPAEDIC TRAUMA INSTITUTE 2550 23RD ST BUILDING 9, 2ND FLOOR
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

ORTHOPAEDIC TRAUMA INSTITUTE 2550 23RD ST BUILDING 9, 2ND FLOOR
SAN FRANCISCO CA
94110
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-4532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberA164084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: