Provider Demographics
NPI:1013162783
Name:MATYAS, CHRISTOPHER EHREN (LMP)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EHREN
Last Name:MATYAS
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 1:2747 PACIFIC AVE SE
Mailing Address - Street 2:STE. A-12
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2097
Mailing Address - Country:US
Mailing Address - Phone:360-704-8093
Mailing Address - Fax:
Practice Address - Street 1:2747 PACIFIC AVE SE
Practice Address - Street 2:STE. A-12
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2097
Practice Address - Country:US
Practice Address - Phone:360-704-8093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-23
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0220995OtherLABOR AND INDUSTRIES