Provider Demographics
NPI:1922025568
Name:MATTHYS, GARY A (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:MATTHYS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 UNIVERSITY DR S
Mailing Address - Street 2:STE 202
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6050
Mailing Address - Country:US
Mailing Address - Phone:701-241-9300
Mailing Address - Fax:
Practice Address - Street 1:2829 UNIVERSITY DR S
Practice Address - Street 2:STE 202
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6050
Practice Address - Country:US
Practice Address - Phone:701-241-9300
Practice Address - Fax:701-235-4525
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND8590207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP32046OtherHEALTH PARTNERS
P00471013OtherRR MEDICARE
0902924OtherMEDICA
ND11431Medicaid
MN7I432MAOtherBCBS MN
C83401026111OtherPREFERRED ONE
MN757678100Medicaid
ND29004OtherBCBS ND
C83401026111OtherPREFERRED ONE
MN757678100Medicaid