Provider Demographics
NPI:1306891494
Name:DOPPELT, MATTHEW BRENT (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRENT
Last Name:DOPPELT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 PINNACLE PT
Mailing Address - Street 2:300
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-6648
Mailing Address - Country:US
Mailing Address - Phone:865-474-8800
Mailing Address - Fax:865-474-8806
Practice Address - Street 1:1924 PINNACLE PT
Practice Address - Street 2:300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6648
Practice Address - Country:US
Practice Address - Phone:865-474-8800
Practice Address - Fax:865-474-8806
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1589207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704460Medicare ID - Type Unspecified
TNH092353Medicare UPIN