Provider Demographics
NPI:1396716411
Name:GRITTERS, MATTHEW A (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:GRITTERS
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 1:405 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1189
Mailing Address - Country:US
Mailing Address - Phone:641-628-6649
Mailing Address - Fax:641-628-6699
Practice Address - Street 1:405 MONROE ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1189
Practice Address - Country:US
Practice Address - Phone:641-628-3832
Practice Address - Fax:641-628-8894
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33009207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5178160Medicaid
IA080171955OtherRAILROAD MEDICAE
IA5178160Medicaid
IAI3024Medicare PIN
IAH05607Medicare UPIN