# DR. PHILIP ALEXANDER MATAVERDE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1992996458
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | 5101017269 | MI | Yes |
| 2084N0400X | Neurology Physician | 2012020702 | MO | — |
| 2084N0400X | Neurology Physician | L1865858 | MI | — |
| 2084S0012X | Sleep Medicine (Psychiatry & Neurology) Physician | 2012020702 | MO | — |

## Other

- **Enumeration date:** 08/08/2007
- **Last updated:** 11/27/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1992996458 | — | MO |
| 01 | — | P01092598 | RAILROAD MEDICARE PTAN | MO |