Individual
MATTHEW R MISNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0102205035
VA
208000000X
Pediatrics Physician
Primary
02004768A
IN
208000000X
Pediatrics Physician
20A11818
CA
208000000X
Pediatrics Physician
4644
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300019274
—
IN
Enumeration date
09/11/2007
Last updated
08/26/2019
Update your record
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