Healthcare Provider Details

I. General information

NPI: 1144078650
Provider Name (Legal Business Name): MATTHEW STEFFENSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH ST STOP 8413
LUBBOCK TX
79430-8143
US

IV. Provider business mailing address

3601 4TH ST STOP 8413
LUBBOCK TX
79430-8143
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-2775
  • Fax:
Mailing address:
  • Phone: 806-743-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number207Q00000X
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: