Healthcare Provider Details

I. General information

NPI: 1639190614
Provider Name (Legal Business Name): MATTHEW BRUCE VUKOSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNC CAMPUS HEALTH SERVICE CB 7470
CHAPEL HILL NC
27599-7470
US

IV. Provider business mailing address

UNC CAMPUS HEALTH SERVICE CB 7470
CHAPEL HILL NC
27599-7470
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-6561
  • Fax: 919-966-0108
Mailing address:
  • Phone: 919-966-6561
  • Fax: 919-966-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number24307
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: