MEDICARE: MATTHEW JUDE PALL AUD

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	231H00000X	Audiologist	LD60966020	WA

General Provider Information

NPI Number	:	1669025987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW JUDE PALL AUD

Provider Business Mailing Address
First Line	:	340 W MAIN ST # 122
Second Line	:
City	:	TREMONTON
State	:	UT
Zip	:	84337-1210
Country	:	US
Telephone Number	:	801-643-5057
Fax Number	:	866-311-6889

Provider Business Practice Location Address
First Line	:	1357 DICKINSON ST APT A
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-3463
Country	:	US
Telephone Number	:	801-643-5057
Fax Number	:

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

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	01/15/2026

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