Provider Demographics
NPI:1316965908
Name:MATTHEWS, EDWIN KEITH (MD)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:KEITH
Last Name:MATTHEWS
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:PO BOX 5750
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601
Mailing Address - Country:US
Mailing Address - Phone:256-355-9040
Mailing Address - Fax:256-355-9048
Practice Address - Street 1:2422 DANVILLE ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603
Practice Address - Country:US
Practice Address - Phone:256-355-9040
Practice Address - Fax:256-355-9048
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25048207Q00000X
AL00025048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630105060Medicaid
51513850OtherBLUE CROSS BLUE SHIELD
AL529402090Medicaid
H26867Medicare UPIN
AL630105060Medicaid