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Individual

MATTHEW J SACKS

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
401 W POPLAR ST, WALLA WALLA, WA 99362-2846
(509) 525-2220
Mailing address
PO BOX 476, WALLA WALLA, WA 99362-0013
(509) 525-2220

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD00041107
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1116094
WA
Enumeration date
05/25/2006
Last updated
07/09/2007
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