Basic Information
| Provider Information | |||||||||
| NPI: | 1780112144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLOBERSON | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | WESLEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 S YALE AVE STE 1400 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184886653 | ||||||||
| FaxNumber: | 9184886098 | ||||||||
| Practice Location | |||||||||
| Address1: | 6475 S YALE AVE STE 401 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741367818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185029555 | ||||||||
| FaxNumber: | 9185029559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2017 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YS0123X | 5101023077 | MI | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5101023077 | 05 | MI | MEDICAID |