Individual
ANGELO MARIO DE MATTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-3442
(503) 494-5330
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-3442
(503) 494-5330
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD192424
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009981555
—
AL
05
—
009981565
—
AL
01
—
04808231
MISSISSIPPI MEDCAID
MS
01
—
051524242
BLUE CROSS
AL
01
—
051524243
BLUE CROSS
AL
01
—
P00159465
RAILROAD MEDICARE
AL
Enumeration date
08/01/2006
Last updated
11/05/2019
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