Individual
MR. MAT EVELETH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2001 CANAL SHORE DR. SW, LECLAIRE, IA 52753
(563) 370-9507
Mailing address
2001 CANAL SHORE DR SW, LE CLAIRE, IA 52753-9564
(563) 370-9507
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
00620
IA
Other
Enumeration date
04/09/2014
Last updated
04/09/2014
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