Provider Demographics
NPI:1053444893
Name:MATTHEWS, PHILIP R (DO)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2025 112TH AVE NE
Mailing Address - Street 2:BLDG 2 STE 300
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-467-5929
Mailing Address - Fax:425-467-5977
Practice Address - Street 1:2025 112TH AVE NE
Practice Address - Street 2:BLDG 2 STE 300
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-467-5929
Practice Address - Fax:425-467-5977
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00000982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D14169Medicare UPIN