Individual
MATTHEW ALAN FRALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1225 GRAHAM RD STE C-2310, FLORISSANT, MO 63031-8023
(618) 228-4215
Mailing address
1225 GRAHAM RD STE C-2310, FLORISSANT, MO 63031-8023
(618) 228-4215
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036-123183
IL
207RC0000X
Cardiovascular Disease Physician
Primary
2004021586
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036.123183
IL LICENSE
IL
01
—
2004021586
MO LICENSE
MO
Enumeration date
02/06/2007
Last updated
02/04/2021
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