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NPI Code Detail

MEDICARE: MATTHEW NEALY FANDRE M.D.

MEDICARE: MATTHEW NEALY FANDRE M.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
1207Q00000XFamily Medicine PhysicianDR.0065194CO

General Provider Information

NPI Number : 1669448163
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW NEALY FANDRE M.D.
Provider Business Mailing Address
First Line : 550 POPE AVE
Second Line :
City : FORT LEAVENWORTH
State : KS
Zip : 66027-2332
Country : US
Telephone Number : 913-684-6250
Fax Number :
Provider Business Practice Location Address
First Line : 1650 COCHRANE CIR UNIT MEDDAC
Second Line :
City : FORT CARSON
State : CO
Zip : 80913-4604
Country : US
Telephone Number : 719-526-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2006
Last Update Date : 06/23/2026

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