Individual
MATTHEW WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2963 W WHITE MOUNTAIN BLVD, LAKESIDE, AZ 85929
(928) 537-5437
(928) 537-5857
Mailing address
1301 S CRISMON RD, MESA, AZ 85209-3767
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
007477
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
386791
—
AZ
Enumeration date
05/19/2015
Last updated
08/31/2018
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