Individual
MR. MATTHEW TYLER KLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1100 9TH AVE, SEATTLE, WA 98101-2756
(206) 624-1144
Mailing address
PO BOX 741515, LOS ANGELES, CA 90074-1515
(206) 515-5811
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA061315
PA
363AM0700X
Medical Physician Assistant
MA061315
PA
363AM0700X
Medical Physician Assistant
Primary
MK8734875
WA
Other
Enumeration date
02/07/2020
Last updated
04/23/2024
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