Provider Demographics
NPI:1013185446
Name:HAGGERTY, MATTHEW D (LMP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:HAGGERTY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 12TH AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2467
Mailing Address - Country:US
Mailing Address - Phone:206-860-7282
Mailing Address - Fax:
Practice Address - Street 1:1605 12TH AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2467
Practice Address - Country:US
Practice Address - Phone:206-860-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist