Provider Demographics
NPI:1952368318
Name:EVITTS, MATTHEW P (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:EVITTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6487
Mailing Address - Country:US
Mailing Address - Phone:541-250-5994
Mailing Address - Fax:541-638-4002
Practice Address - Street 1:525 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6487
Practice Address - Country:US
Practice Address - Phone:541-250-5994
Practice Address - Fax:541-638-4002
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO228772085R0202X, 204D00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287713Medicaid
ORH21114Medicare UPIN
OR287713Medicaid