Provider Demographics
NPI:1215934179
Name:ROES, MATTHEW J (DC, MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:ROES
Suffix:
Gender:M
Credentials:DC, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 N CENTER POINT RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1226
Mailing Address - Country:US
Mailing Address - Phone:319-294-3263
Mailing Address - Fax:
Practice Address - Street 1:754 N CENTER POINT RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1226
Practice Address - Country:US
Practice Address - Phone:319-294-3263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI20689Medicare PIN