Healthcare Provider Details

I. General information

NPI: 1356963482
Provider Name (Legal Business Name): SAMUEL ROBERT MATZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 S RESERVE ST STE 101
MISSOULA MT
59801-3103
US

IV. Provider business mailing address

1211 S RESERVE ST STE 101
MISSOULA MT
59801-3103
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-3057
  • Fax: 406-327-3231
Mailing address:
  • Phone: 406-327-3057
  • Fax: 406-327-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMED-PHYS-LIC-118389
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: