Provider Demographics
NPI:1447280821
Name:MATZ, PAUL G (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:MATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51088
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-1088
Mailing Address - Country:US
Mailing Address - Phone:307-266-4000
Mailing Address - Fax:307-233-0266
Practice Address - Street 1:6600 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4348
Practice Address - Country:US
Practice Address - Phone:307-266-4000
Practice Address - Fax:307-233-0266
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23930207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051502336Medicaid
WY153934500Medicaid
AL020049379OtherRAILROAD MEDICARE
MS00126097OtherMISSISSIPPI MEDICAID
AL009960280Medicaid
AL051502338OtherBLUE CROSS
AL051502336OtherBLUE CROSS