Individual
MATTHEW IWAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
222 N 7TH ST, BISMARCK, ND 58501-4436
(701) 323-6000
Mailing address
PO BOX 5501, BISMARCK, ND 58506-5501
(323) 701-6000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G56369
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G563690
BLUE SHIELD
CA
05
—
00G563690
—
CA
Enumeration date
07/10/2006
Last updated
02/07/2013
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