Individual
MATTHEW LAVALLEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
200 BRULE ST BLDG 871, FORT KNOX, KY 40121-6100
(253) 968-2252
Mailing address
62ND MED BDE, JOINT BASE LEWIS MCCHORD, WA 98433
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
03/06/2018
Last updated
08/15/2025
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