Provider Demographics
NPI:1891124970
Name:MATTHEWS, MOLLY ANNE (PAC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANNE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 E BARNETT RD # MSS
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8332
Mailing Address - Country:US
Mailing Address - Phone:541-789-4281
Mailing Address - Fax:541-789-4806
Practice Address - Street 1:2900 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8458
Practice Address - Country:US
Practice Address - Phone:541-789-5790
Practice Address - Fax:541-789-5973
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA205662363AM0700X
COPA0003834363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPA0003834OtherCOLORADO LICENSE
ORPA205662OtherOREGON MEDICAL BOARD