Basic Information
| Provider Information | |||||||||
| NPI: | 1104035062 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROUNDS | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | DWIGHT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5644 W DIAMOND DR | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648014667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176268287 | ||||||||
| FaxNumber: | 4175762544 | ||||||||
| Practice Location | |||||||||
| Address1: | 1102 W 32ND ST | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648043503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173471111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2009010342 | MO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.