Healthcare Provider Details

I. General information

NPI: 1063483071
Provider Name (Legal Business Name): MATTHEW REED PARSONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 N STATE ST
PROVO UT
84604-1010
US

IV. Provider business mailing address

1735 N STATE ST
PROVO UT
84604-1010
US

V. Phone/Fax

Practice location:
  • Phone: 801-374-1818
  • Fax: 801-379-2959
Mailing address:
  • Phone: 801-374-1818
  • Fax: 801-374-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number901823741205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: