Provider Demographics
NPI:1609930759
Name:HUBBARD, MATTHEW BRIGGS (LMP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:BRIGGS
Last Name:HUBBARD
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 1:1555 ANACORTES AVE NE
Mailing Address - Street 2:B-208
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3911
Mailing Address - Country:US
Mailing Address - Phone:425-444-2604
Mailing Address - Fax:
Practice Address - Street 1:15935 NE 8TH ST
Practice Address - Street 2:SUITE A-101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-3918
Practice Address - Country:US
Practice Address - Phone:425-644-5556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA7054174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist