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Organization
WEST OLYMPIA FAMILY MEDICINE INC, PC
Active
Organization
WEST OLYMPIA FAMILY MEDICINE INC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW T. WELLOCK M.D. (OWNER)
(360) 754-4837
Entity
Organization
Contact information
Practice address
402 BLACK HILLS LN SW STE B, OLYMPIA, WA 98502-8146
(360) 754-4837
(360) 754-7304
Mailing address
1401 MARVIN RD NE STE 307 PMB 266, LACEY, WA 98516-5710
(360) 491-5055
(360) 491-5890
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00045733
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124098
—
WA
Enumeration date
04/25/2007
Last updated
04/20/2008
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