MEDICARE: DR. MATTHEW J MERMER MD

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	A71955	CA
2	207X00000X	Orthopaedic Surgery Physician	A71955	CA

General Provider Information

NPI Number	:	1710989736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW J MERMER MD

Provider Business Mailing Address
First Line	:	1600 EUREKA RD
Second Line	:	ORTHOPAEDICS 2ND FLOOR
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3027
Country	:	US
Telephone Number	:	916-784-5268
Fax Number	:	916-784-5194

Provider Business Practice Location Address
First Line	:	1600 EUREKA RD
Second Line	:	ORTHOPAEDICS 2ND FLOOR
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3027
Country	:	US
Telephone Number	:	916-784-5268
Fax Number	:	916-784-5194

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	12/13/2021

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