Individual
BERTRAM T MATSUMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3200 S COUNTRY CLUB WAY, TEMPE, AZ 85282-4054
(480) 839-0206
(480) 839-0208
Mailing address
3200 S COUNTRY CLUB WAY, TEMPE, AZ 85282-4054
(480) 839-0206
(480) 839-0208
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
24096
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
358988
—
AZ
01
—
6536800
CIGNA
AZ
01
—
AZ0393470
BCBS AZ
AZ
Enumeration date
06/08/2005
Last updated
10/31/2011
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