Individual
MATTHEW JAY KOGUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
325 9TH AVE, SEATTLE, WA 98104
(206) 543-6420
Mailing address
325 9TH AVE, SEATTLE, WA 98104
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
MD60002838
WA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
MD60002838
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0264688
L AND I
WA
05
—
1366554412
—
WA
Enumeration date
08/31/2006
Last updated
10/11/2018
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