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General NPI Number Information
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NPI Number | 1407184070
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Entity Type | Organization
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Legal Business Name | GARY A MATTHYS MD PLC
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 129 E LINCOLN AVE
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City | FERGUS FALLS
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State | MN
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Zip | 56537-2283
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Country | US
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Telephone | 218-998-2663
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Fax | 701-235-4525
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Provider Business Mailing Address
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Address Line | 2301 25TH ST S SUITE I
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City | FARGO
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State | ND
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Zip | 58103-6104
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Country | US
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Telephone | 701-241-9300
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Fax | 701-235-4525
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ABBY LEWIS
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Credential |
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Telephone | 701-241-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 8590
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License Number State | ND
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