Individual
JACOB MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2720 CLARE AVE, SUITE A, BREMERTON, WA 98310-3374
(360) 479-6154
(360) 479-5728
Mailing address
2520 CHERRY AVE, BREMERTON, WA 98310-4229
(360) 479-6154
(360) 479-5728
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD60277434
WA
207R00000X
Internal Medicine Physician
ME99988
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001333300
—
FL
Enumeration date
07/14/2008
Last updated
07/31/2012
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