| Evan J Matheson | |
|
745 N 500 W # 200 Provo UT 84601-1472 | |
| (801) 375-9292 | |
| (801) 375-9290 |
| Full Name | Evan J Matheson |
|---|---|
| Speciality | Clinic/Center |
| Location | 745 N 500 W # 200, Provo, Utah |
| Authorized Official Name and Position | Evan J Matheson (OWNER) |
| Authorized Official Contact | 8013759292 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evan J Matheson 745 N 500 W # 200 Provo UT 84601-1472 Ph: (801) 375-9292 | Evan J Matheson 745 N 500 W # 200 Provo UT 84601-1472 Ph: (801) 375-9292 |
| NPI Number | 1760677686 |
|---|---|
| Provider Enumeration Date | 09/13/2007 |
| Last Update Date | 01/31/2011 |
| Medicare PECOS PAC ID | 6608809637 |
|---|---|
| Medicare Enrollment ID | O20050912000393 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760677686 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Evan J Matheson |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1649251646 PECOS PAC ID: 1052591286 Enrollment ID: I20110204000955 |
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