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General NPI Number Information
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NPI Number | 1265827620
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Entity Type | Individual
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Provider Name | CHRISTIAN MATAR
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Gender | Male
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 550 S JACKSON ST THIRD FLOOR, SUITE A3K00
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City | LOUISVILLE
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State | KY
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Zip | 40202-1622
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Country | US
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Telephone | 502-852-4277
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Fax |
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Provider Business Mailing Address
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Address Line | 741 PRESIDENT PL STE 200
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City | SMYRNA
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State | TN
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Zip | 37167-6809
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Country | US
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Telephone | 615-459-7104
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Fax | 615-459-7822
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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 | 59455
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License Number State | TN
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