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General NPI Number Information
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NPI Number | 1104867456
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Entity Type | Individual
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Provider Name | MATTHEW L. OFFUTT M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 4423 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40218-3235
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Country | US
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Telephone | 502-495-2400
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Fax | 502-499-3606
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Provider Business Mailing Address
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Address Line | 2700 STANLEY GAULT PARKWAY 129
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City | LOUISVILLE
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State | KY
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Zip | 40223-5176
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Country | US
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Telephone | 502-253-4900
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Fax | 502-489-5751
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34028
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License Number State | KY
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