Basic Information
| Provider Information | |||||||||
| NPI: | 1881850907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLETT | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | DALE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7060 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852467060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804442017 | ||||||||
| FaxNumber: | 4805457181 | ||||||||
| Practice Location | |||||||||
| Address1: | 595 N DOBSON RD STE D65 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852244234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807181300 | ||||||||
| FaxNumber: | 4805457181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2008 | ||||||||
| LastUpdateDate: | 11/15/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5885 | NE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 7177 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.