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General NPI Number Information
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NPI Number | 1326833104
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Entity Type | Individual
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Provider Name | MATTHEW WALTER HUCEK MD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | US 191 & AZ 264
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City | GANADO
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State | AZ
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Zip | 86505
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Country | US
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Telephone | 928-755-4933
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Fax |
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Provider Business Mailing Address
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Address Line | 6229 E ARABIAN WAY
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-1845
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Country | US
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Telephone | 480-307-2086
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Fax |
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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 | R79799
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License Number State | AZ
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