Provider Demographics
NPI:1811974686
Name:THACHER, MATTHEW G SR
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:G
Last Name:THACHER
Suffix:SR
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 1:1519 ALASKAN WAY S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-1102
Mailing Address - Country:US
Mailing Address - Phone:206-217-6439
Mailing Address - Fax:206-217-6636
Practice Address - Street 1:1519 ALASKAN WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1102
Practice Address - Country:US
Practice Address - Phone:206-217-6439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider