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General NPI Number Information
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NPI Number | 1669025987
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Entity Type | Individual
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Provider Name | MATTHEW JUDE PALL AUD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 1357 DICKINSON ST APT A
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City | MISSOULA
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State | MT
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Zip | 59802-3463
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Country | US
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Telephone | 801-643-5057
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Fax |
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Provider Business Mailing Address
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Address Line | 340 W MAIN ST # 122
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City | TREMONTON
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State | UT
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Zip | 84337-1210
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Country | US
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Telephone | 801-643-5057
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Fax | 866-311-6889
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | LD60966020
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License Number State | WA
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