Individual
MATTHEW L SUBLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2605 KENTUCKY AVE, SUITE 301, PADUCAH, KY 42003-3800
(270) 443-1220
(270) 443-0023
Mailing address
2605 KENTUCKY AVE, SUITE 306, PADUCAH, KY 42003-3800
(270) 415-7653
(270) 575-8359
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
MD00048039
WA
207VG0400X
Gynecology Physician
Primary
TP285
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0220235
L&I
WA
05
—
1639397359
—
WA
01
—
8944558
CV
WA
01
—
P01257175
RR MEDICARE
WA
Enumeration date
04/20/2007
Last updated
08/18/2016
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