Individual
DR. ALLAN LEE MATTERN I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 S 5TH ST, DOUGLAS, WY 82633-2434
(307) 358-7300
Mailing address
111 S 5TH ST, DOUGLAS, WY 82633-2434
(307) 358-7300
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
3059A
WY
207RC0000X
Cardiovascular Disease Physician
Primary
3059A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060025397
RR MCARE - WCPS
WY
01
—
060040677
RAILROAD MEDICARE
WY
05
—
102651800
—
WY
01
—
304480
BLUE SHIELD
WY
Enumeration date
01/02/2007
Last updated
12/22/2016
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