Individual
DR. JACQUELINE R MATAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
701 BOB O LINK DR, SUITE 120, LEXINGTON, KY 40504-3759
(859) 277-3737
(859) 277-3765
Mailing address
870 CORPORATE DR, STE. 400, LEXINGTON, KY 40503-5416
(859) 277-9436
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
24630
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64246309
—
KY
01
—
920006560
RR MEDICARE
KY
Enumeration date
08/03/2005
Last updated
01/30/2013
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