Provider Demographics
NPI:1841559820
Name:SURRUSCO, MATTHEW SALAZAR (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SALAZAR
Last Name:SURRUSCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 TALBOT RD S STE 530
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5700
Mailing Address - Country:US
Mailing Address - Phone:425-690-3433
Mailing Address - Fax:254-690-9433
Practice Address - Street 1:4033 TALBOT RD S STE 530
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5700
Practice Address - Country:US
Practice Address - Phone:425-690-3433
Practice Address - Fax:254-690-9433
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60875669208600000X, 2086S0127X
IDMC-27742086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2105120Medicaid