Provider Demographics
NPI:1346247293
Name:FEWEL, MATTHEW EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EVAN
Last Name:FEWEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3730 PLAZA WAY
Mailing Address - Street 2:PO BOX 6128
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-0128
Mailing Address - Country:US
Mailing Address - Phone:509-221-6550
Mailing Address - Fax:509-221-6511
Practice Address - Street 1:3730 PLAZA WAY
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2718
Practice Address - Country:US
Practice Address - Phone:509-221-6550
Practice Address - Fax:509-221-6511
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00044896207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8523920Medicaid
WA0238985OtherLABOR & INDUSTRIES
WA8872938Medicare PIN