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General NPI Number Information
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NPI Number | 1821289893
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Entity Type | Individual
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Provider Name | CHANCE LEE MATTHIESEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 932 E 34TH ST
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City | JOPLIN
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State | MO
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Zip | 64804-3932
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Country | US
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Telephone | 417-347-2200
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Fax | 417-347-2204
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Provider Business Mailing Address
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Address Line | PO BOX 3810
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City | JOPLIN
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State | MO
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Zip | 64803-3810
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Country | US
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Telephone | 417-347-2200
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Fax | 417-347-2204
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 25819
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 2016036874
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License Number State | MO
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