Individual
MATTHEW PAVELKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1003 WILLOW CREEK RD, PRESCOTT, AZ 86301-1641
(928) 445-2700
Mailing address
153 HERONDO ST, HERMOSA BEACH, CA 90254-5153
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
49333
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
924528
—
AZ
Enumeration date
07/16/2010
Last updated
09/04/2020
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