Provider Demographics
NPI:1942903141
Name:ROBERTS, MATTHEW (ARNP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-5406
Mailing Address - Country:US
Mailing Address - Phone:406-529-2690
Mailing Address - Fax:
Practice Address - Street 1:220 E ROWAN AVE STE 150
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2244
Practice Address - Country:US
Practice Address - Phone:509-483-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61418887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine