Individual
MR. MATTHEW MELVIN TIEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
395 W COUGAR BLVD STE 803, PROVO, UT 84604-3311
(801) 235-7246
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
57636701206
UT
363AM0700X
Medical Physician Assistant
57636701206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578992012
—
UT
Enumeration date
11/05/2013
Last updated
10/25/2024
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