Provider Demographics
NPI:1104149715
Name:MINOR, MATTHEW RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RAYMOND
Last Name:MINOR
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 1:3650 PIPER ST STE A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4651
Mailing Address - Country:US
Mailing Address - Phone:907-339-9455
Mailing Address - Fax:907-339-9445
Practice Address - Street 1:3650 PIPER ST STE A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4651
Practice Address - Country:US
Practice Address - Phone:907-339-9455
Practice Address - Fax:907-339-9445
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012502532085R0202X
AK1011752085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology