MEDICARE: DR. MATT S. GEE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1063605277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATT S. GEE PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 6671
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95406-0671
Country	:	US
Telephone Number	:	707-544-7331
Fax Number	:	707-623-9409

Provider Business Practice Location Address
First Line	:	1812 W BURBANK BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-1315
Country	:	US
Telephone Number	:	213-446-0765
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	02/10/2016

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