Individual
MATTHEW J CONCANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3115 FALLING LEAF CT, COLUMBIA, MO 65201-3579
(573) 449-5000
(573) 449-5010
Mailing address
3115 FALLING LEAF CT, COLUMBIA, MO 65201-3579
(573) 449-5000
(573) 449-5010
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
MDR7H73
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1304006
UNITED HEALCARE
MO
01
—
289606
HEALTHLINK
MO
01
—
31925
BLUE CHOICE
MO
Enumeration date
05/20/2006
Last updated
07/08/2007
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