Basic Information
| Provider Information | |||||||||
| NPI: | 1366422727 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEORIO | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 927 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565392728 | ||||||||
| FaxNumber: | 2565392666 | ||||||||
| Practice Location | |||||||||
| Address1: | 927 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565392728 | ||||||||
| FaxNumber: | 2565392666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 05/18/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 28782 | AL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000102657 | 05 | AL | MEDICAID | 7881949 | 01 | AL | AETNA | OTHER | Z01267 | 01 | AL | VIVA HEALTHCARE | OTHER | 09-01497 | 01 | AL | UNITED HEALTHCARE | OTHER | 51040155 | 01 | AL | BCBS | OTHER | 51042058 | 01 | AL | BCBS | OTHER | P00030620 | 01 | AL | RAILROAD MEDICARE | OTHER |