Healthcare Provider Details

I. General information

NPI: 1144153776
Provider Name (Legal Business Name): MR. MATTHEW SPIVEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W 10TH ST
MEDFORD OR
97501-3106
US

IV. Provider business mailing address

609 W 10TH ST
MEDFORD OR
97501-3106
US

V. Phone/Fax

Practice location:
  • Phone: 541-774-4810
  • Fax:
Mailing address:
  • Phone: 541-774-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1306081542
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: