Provider Demographics
NPI:1841235645
Name:ISHO, MATHEW S (MD)
Entity Type:Individual
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First Name:MATHEW
Middle Name:S
Last Name:ISHO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4060 4TH AVE
Mailing Address - Street 2:STE 510
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2121
Mailing Address - Country:US
Mailing Address - Phone:619-686-4011
Mailing Address - Fax:619-686-4041
Practice Address - Street 1:550 WASHINGTON ST
Practice Address - Street 2:SUITE 821
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2213
Practice Address - Country:US
Practice Address - Phone:619-686-4011
Practice Address - Fax:619-686-4041
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2020-06-12
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Provider Licenses
StateLicense IDTaxonomies
CAA93470208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I16512Medicare UPIN