Basic Information
| Provider Information | |||||||||
| NPI: | 1013531367 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAULSON | ||||||||
| FirstName: | MATT | ||||||||
| MiddleName: | DONALD | ||||||||
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| Credential: | R.T.(R) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5909 CANSLER DR | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366097023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2566043773 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3719 DAUPHIN ST | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366081753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513449630 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2020 | ||||||||
| LastUpdateDate: | 06/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247100000X | 588323 | AL | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist |
No ID Information.