Healthcare Provider Details

I. General information

NPI: 1336544212
Provider Name (Legal Business Name): ROBERT KYLE MATTHEWS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 DELHI ST
DUBUQUE IA
52001
US

IV. Provider business mailing address

1515 DELHI ST
DUBUQUE IA
52001-6320
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-5991
  • Fax: 563-589-4078
Mailing address:
  • Phone: 563-557-5991
  • Fax: 563-589-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number138648
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: