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General NPI Number Information
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NPI Number | 1417463969
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Entity Type | Individual
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Provider Name | MATTHEW DAVID VANVALIN PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 7707 S MEMORIAL DR
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City | TULSA
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State | OK
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Zip | 74133-3643
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Country | US
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Telephone | 872-231-3162
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Fax | 702-977-1496
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Provider Business Mailing Address
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Address Line | PO BOX 74008272
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City | CHICAGO
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State | IL
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Zip | 60674-8272
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Country | US
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Telephone | 702-899-0595
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Fax | 702-977-1496
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2874
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License Number State | OK
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