Individual
MATTHEW JOHN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1900 W SUNSHINE ST, SPRINGFIELD, MO 65807-2240
(417) 862-7041
Mailing address
8310 SHINNECOCK DR, NIXA, MO 65714-7372
(417) 838-7827
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
145210
MO
Other
Enumeration date
12/13/2022
Last updated
12/13/2022
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