Provider Demographics
NPI:1871737544
Name:GISH, MATTHEW JAYE (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAYE
Last Name:GISH
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 1:1133 COLLEGE AVE STE E120
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2781
Mailing Address - Country:US
Mailing Address - Phone:785-539-7641
Mailing Address - Fax:
Practice Address - Street 1:1133 COLLEGE AVE STE E120
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2781
Practice Address - Country:US
Practice Address - Phone:785-539-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-26
Last Update Date:2009-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS324562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology