Organization
TAG MEDICAL & STAFFING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW CLARK PHYSICIAN ASSISTANT (CEO)
(254) 931-8298
Entity
Organization
Contact information
Practice address
2601 N 3RD ST STE 106, PHOENIX, AZ 85004-1144
(254) 931-8298
(602) 248-8006
Mailing address
2371 E AZALEA DR, CHANDLER, AZ 85286-2365
(254) 931-8298
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1035995
NCCPA
—
01
—
2124
STATE LICENSE
AZ
Enumeration date
05/11/2019
Last updated
05/11/2019
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