Provider Demographics
NPI:1851566822
Name:MATTHEWS, JESSE DEAN
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:DEAN
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N 59TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5835
Mailing Address - Country:US
Mailing Address - Phone:206-618-9631
Mailing Address - Fax:
Practice Address - Street 1:2500 NE NEFF ROAD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-706-5811
Practice Address - Fax:541-526-6675
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60221495208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist