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Individual
MATTHEW J FACKRELL
Active
Individual
MATTHEW J FACKRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
DO221842
OR
207Q00000X
Family Medicine Physician
Primary
DR.0073268
CO
207Q00000X
Family Medicine Physician
OP61556804
WA
207Q00000X
Family Medicine Physician
OS024313
PA
Other
Enumeration date
07/06/2006
Last updated
10/22/2024
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