Healthcare Provider Details

I. General information

NPI: 1073573481
Provider Name (Legal Business Name): RICHARD MATTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 BOB O LINK DR STE 120
LEXINGTON KY
40504-3759
US

IV. Provider business mailing address

870 CORPORATE DR STE. 400
LEXINGTON KY
40503-5416
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-3737
  • Fax:
Mailing address:
  • Phone: 859-277-9436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4301039400
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: