MEDICARE: MR. JOHN M. MATUNIS 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	363A00000X	Physician Assistant	MA001741L	PA

General Provider Information

NPI Number	:	1598727265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN M. MATUNIS PA-C

Provider Business Mailing Address
First Line	:	2496 RICKER RD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79916
Country	:	US
Telephone Number	:	915-742-2260
Fax Number	:	570-271-6578

Provider Business Practice Location Address
First Line	:	2496 RICKER RD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79916
Country	:	US
Telephone Number	:	915-742-2260
Fax Number	:

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	04/17/2024

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