MEDICARE: MATTHEW BRETT DOHLMAN P.A.

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	207N00000X	Dermatology Physician	APA1311	OK
2	363AM0700X	Medical Physician Assistant	1311	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245262419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW BRETT DOHLMAN P.A.

Provider Business Mailing Address
First Line	:	9245 S MINGO RD
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-5793
Country	:	US
Telephone Number	:	918-492-8980
Fax Number	:	918-495-0607

Provider Business Practice Location Address
First Line	:	9245 S MINGO RD
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-5793
Country	:	US
Telephone Number	:	918-492-8980
Fax Number	:	918-495-0607

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/19/2016

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