Provider Demographics
NPI:1316232606
Name:DOEPKER, MATTHEW P (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:P
Last Name:DOEPKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 MIAMI VALLEY DR STE 350
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1294
Mailing Address - Country:US
Mailing Address - Phone:937-424-2469
Mailing Address - Fax:937-424-2479
Practice Address - Street 1:2300 MIAMI VALLEY DR STE 350
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-1294
Practice Address - Country:US
Practice Address - Phone:937-424-2469
Practice Address - Fax:937-424-2479
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC392552086X0206X, 208600000X
OH35.1348022086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0316031Medicaid
SC39255OtherLICENSE
SC392550Medicaid
SC392550Medicaid