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Individual

MATTHEW TYLER PACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1260 N ARENDELL AVE, ZEBULON, NC 27597-8730
(919) 235-1965
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0351
(919) 350-7687

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-11059
NC
363AM0700X
Medical Physician Assistant
Primary
0010-11059
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1801404496
NC
Enumeration date
07/20/2020
Last updated
05/24/2024
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