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Individual
DR. MATTHEW TODD DESJARDINS
Active
Individual
DR. MATTHEW TODD DESJARDINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
38980
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000333833
ANTHEM
KY
01
—
0428850004
MEDICARE DME
KY
05
—
64088594
—
KY
01
—
90008962
MEDICAID DME
KY
01
—
CB8861
RAILROAD MEDICARE
KY
01
—
P00156471
RAILROAD MEDICARE
KY
Enumeration date
06/01/2005
Last updated
05/11/2015
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