Individual
BRYAN K. MATANKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1760 E FLORENCE BLVD, SUITE 120, CASA GRANDE, AZ 85222-4764
(520) 426-1000
(520) 426-1395
Mailing address
1760 E FLORENCE BLVD, SUITE 120, CASA GRANDE, AZ 85222-4764
(520) 426-1000
(520) 426-1395
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
22110
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0046722
DEPT. LABOR
AZ
05
—
15781901
—
AZ
01
—
1Z1375
HEALTHNET
AZ
01
—
200018286
RR MEDICARE
AZ
01
—
86-0754243
IRS TAX ID
AZ
01
—
AZ0351140
BC/BS
AZ
01
—
F66298
MERCY HEALTH PLANS
AZ
Enumeration date
08/30/2006
Last updated
07/21/2022
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