Individual
MATTHEW M DIESSELHORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10914 HEFNER POINTE DR STE 200, OKLAHOMA CITY, OK 73120-5069
(405) 463-3337
(405) 463-3338
Mailing address
10914 HEFNER POINTE DR STE 200, OKLAHOMA CITY, OK 73120-5069
(405) 463-3337
(405) 463-3338
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
25730
OK
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
25730
OK
207XX0801X
Orthopaedic Trauma Physician
25730
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25730
MEDICAL LICENSE
OK
Enumeration date
06/23/2007
Last updated
04/07/2020
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