Basic Information
Provider Information
NPI: 1003017971
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TWEET
FirstName: MATTHEW
MiddleName: LEE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10470 OLD PLACERVILLE RD
Address2: SUITE 100
City: SACRAMENTO
State: CA
PostalCode: 958272539
CountryCode: US
TelephoneNumber: 8004700071
FaxNumber:  
Practice Location
Address1: 2725 CAPITOL AVE
Address2: SUITE 302
City: SACRAMENTO
State: CA
PostalCode: 958166004
CountryCode: US
TelephoneNumber: 9162629440
FaxNumber: 9162629445
Other Information
ProviderEnumerationDate: 05/30/2007
LastUpdateDate: 08/08/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XA111016CAY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


Home