Provider Demographics
NPI:1770511040
Name:DEVANE, MATTHEW S (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:DEVANE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:106 LA CASA VIA
Mailing Address - Street 2:#140
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-274-2860
Mailing Address - Fax:925-932-4527
Practice Address - Street 1:106 LA CASA VIA
Practice Address - Street 2:#140
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3086
Practice Address - Country:US
Practice Address - Phone:925-274-2860
Practice Address - Fax:925-932-4527
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-11-07
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Provider Licenses
StateLicense IDTaxonomies
CA20A7765207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G92433Medicare UPIN