Provider Demographics
NPI:1699706358
Name:MATTHEES, DONALD J (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:MATTHEES
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 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4549207RP1001X
MN31613207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4800136OtherMEDICA #
ND325OtherNDBS #
ND4800204OtherMEDICA #
NDHP25806OtherHEALTHPARTNERS #
NDND200048OtherLHS #
NDDA9011015563OtherPREFERRED ONE #
ND4800131OtherMEDICA #
ND905894OtherAMERICA'S PPO/ARAZ #
ND142037OtherUCARE #
ND13771Medicaid
ND325Medicare ID - Type UnspecifiedND MEDICARE #
ND905894OtherAMERICA'S PPO/ARAZ #