Basic Information
| Provider Information | |||||||||
| NPI: | 1750720447 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | KURTIS | ||||||||
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| Credential: | AA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7660 WOODVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | SAINT PARIS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430729317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373622660 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 455021312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777089753 | ||||||||
| FaxNumber: | 9375213910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2013 | ||||||||
| LastUpdateDate: | 06/17/2013 | ||||||||
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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 | 367H00000X | 67000217 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
No ID Information.