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Individual
MATTHEW STEVEN STAKE
Active
Individual
MATTHEW STEVEN STAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA059828
PA
363A00000X
Physician Assistant
Primary
OA004494
PA
363AM0700X
Medical Physician Assistant
MA059828
PA
363AM0700X
Medical Physician Assistant
OA004494
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103552557
—
PA
01
—
727045
PA
PA
Enumeration date
07/09/2018
Last updated
10/03/2022
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