Provider Demographics
NPI:1578946513
Name:YAMAMOTO, MATTHEW M (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 E HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1417
Mailing Address - Country:US
Mailing Address - Phone:509-252-1900
Mailing Address - Fax:509-277-7070
Practice Address - Street 1:551 E HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1417
Practice Address - Country:US
Practice Address - Phone:509-252-1900
Practice Address - Fax:509-277-7070
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60558344363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant