Provider Demographics
NPI:1669867867
Name:ARROYO, MATT (DO)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:ARROYO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 SPRUCE CT
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-4340
Mailing Address - Country:US
Mailing Address - Phone:614-886-4355
Mailing Address - Fax:
Practice Address - Street 1:3525 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1221
Practice Address - Country:US
Practice Address - Phone:937-395-8839
Practice Address - Fax:937-395-8387
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.013365207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program