Individual
TIMOTHY D MATTHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
353 FAIRMONT BLVD, RAPID CITY, SD 57701
(605) 719-1000
Mailing address
353 FAIRMONT BLVD, ATTEN MEDICAL STAFF SERVICES, RAPID CITY, SD 57701-6000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CR000660
SD
367500000X
Certified Registered Nurse Anesthetist
R029305
SD
367500000X
Certified Registered Nurse Anesthetist
R49054
ND
Other
Enumeration date
08/30/2006
Last updated
12/28/2023
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