MEDICARE: MATTHEW CHRISTOPHER PA-C

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	363AM0700X	Medical Physician Assistant	311061-1206	UT

General Provider Information

NPI Number	:	1578752218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW CHRISTOPHER PA-C

Provider Business Mailing Address
First Line	:	9690 S 1300 E
Second Line	:	SUITE 100
City	:	SANDY
State	:	UT
Zip	:	84094-3721
Country	:	US
Telephone Number	:	801-571-5121
Fax Number	:	801-572-5358

Provider Business Practice Location Address
First Line	:	9690 S 1300 E
Second Line	:	SUITE 100
City	:	SANDY
State	:	UT
Zip	:	84094-3721
Country	:	US
Telephone Number	:	801-571-5121
Fax Number	:	801-572-5358

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	11/12/2021

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