Individual
DR. DANIEL T MATTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12266 DE PAUL DR STE 100, BRIDGETON, MO 63044-2541
(314) 738-2770
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
036111157
IL
2084N0400X
Neurology Physician
Primary
2004003731
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207277104
—
MO
Enumeration date
12/28/2005
Last updated
10/23/2020
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