Provider Demographics
NPI:1962068395
Name:GUETZLAFF, MATTHEW (DPM)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GUETZLAFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 PAN AMERICAN FWY NE STE 234
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6834
Mailing Address - Country:US
Mailing Address - Phone:505-880-1000
Mailing Address - Fax:
Practice Address - Street 1:4343 PAN AMERICAN FWY NE STE 234
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6834
Practice Address - Country:US
Practice Address - Phone:505-880-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NMPOD472213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program