Provider Demographics
NPI:1447343330
Name:MATSON, MARK ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:MATSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1000 WESTGATE DRIVE
Mailing Address - Street 2:SUITE 149
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-5000
Mailing Address - Country:US
Mailing Address - Phone:651-641-2924
Mailing Address - Fax:651-641-2901
Practice Address - Street 1:1000 WESTGATE DRIVE
Practice Address - Street 2:SUITE 149
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-5000
Practice Address - Country:US
Practice Address - Phone:651-641-2924
Practice Address - Fax:651-641-2901
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-03-22
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Provider Licenses
StateLicense IDTaxonomies
MN32891207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNE48295Medicare UPIN