Individual
MATTHEW RUSSELL REPP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10494 W THUNDERBIRD BLVD STE 108, SUN CITY, AZ 85351-6122
(866) 974-2673
(866) 939-2673
Mailing address
18444 N 25TH AVE STE 310, PHOENIX, AZ 85023-1266
(866) 974-2673
(866) 939-2673
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9012
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125508
—
AZ
Enumeration date
04/21/2022
Last updated
08/11/2025
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