Provider Demographics
NPI:1033600044
Name:PREVOST, MATTHEW AARON (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:AARON
Last Name:PREVOST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:87 19TH ST W STE 300
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-5430
Mailing Address - Country:US
Mailing Address - Phone:205-221-3606
Mailing Address - Fax:659-675-2225
Practice Address - Street 1:87 19TH ST W STE 300
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-5430
Practice Address - Country:US
Practice Address - Phone:205-221-3606
Practice Address - Fax:659-675-2225
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009141207X00000X
ALMD.48713207XS0117X, 207X00000X
TXU2294207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU2294OtherTEXAS MEDICAL BOARD