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General NPI Number Information
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NPI Number | 1891310371
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Entity Type | Individual
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Provider Name | DAVID JOSEPH MATTHEWS RRT
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Gender | Male
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 06/10/2020
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Provider Practice Location Address
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Address Line | 520 S EAGLE RD
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City | MERIDIAN
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State | ID
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Zip | 83642-6351
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Country | US
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Telephone | 208-381-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 6020 S SEA BREEZE WAY
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City | BOISE
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State | ID
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Zip | 83709-5791
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Country | US
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Telephone | 208-608-3991
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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 | 227900000X
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Taxonomy Name | Registered Respiratory Therapist
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License Number | LRT-777
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License Number State | ID
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