Individual
JACOB MATHESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1344 WINTERGREEN LN NE, BAINBRIDGE ISLAND, WA 98110-5147
(206) 842-5632
(206) 842-5992
Mailing address
PO BOX 741515, LOS ANGELES, CA 90074-1515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP61307188
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2214646
—
WA
Enumeration date
05/04/2022
Last updated
10/09/2025
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