Provider Demographics
NPI:1275634552
Name:MATTHEWS, WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 COYLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608
Mailing Address - Country:US
Mailing Address - Phone:916-536-3540
Mailing Address - Fax:916-536-2455
Practice Address - Street 1:3160 FOLSOM BLVD.
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28635207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA010994OtherHEALTH NET
CA12454OtherINTERPLAN
CA657319OtherGREAT WEST
CA726411OtherUNITED HEALTHCARE
CA90015434OtherPACIFICARE
CAA28635OtherBLUE CROSS
CA00A286350Medicaid
CA4119623OtherAETNA
CAMCMG321900OtherWESTERN HEALTH ADVANTAGE
CA25529OtherFIRST HEALTH
CA6066550OtherCIGNA
CA657319OtherGREAT WEST
CAA25454Medicare UPIN