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General NPI Number Information
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NPI Number | 1730686643
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Entity Type | Individual
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Provider Name | MATTHEW WAYNE MCEWEN MD
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Gender | Male
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Dates
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Enumeration Date | 04/07/2018
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 276 NE TUDOR RD
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City | LEES SUMMIT
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State | MO
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Zip | 64086-5696
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Country | US
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Telephone | 816-525-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 276 NE TUDOR RD
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City | LEES SUMMIT
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State | MO
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Zip | 64086-5696
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Country | US
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Telephone | 816-525-8500
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2024001826
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 2024001826
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License Number State | MO
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