Individual
MATTHEW JAMES SHIVELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1313 BROADWAY PLAZA, STE 200, TACOMA, WA 98402-3400
(253) 426-6306
(253) 426-6344
Mailing address
1313 BROADWAY PLAZA, STE 200, TACOMA, WA 98402-3400
(253) 426-6306
(253) 426-6344
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD00046533
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0242294
STATE L&I
WA
Enumeration date
09/15/2006
Last updated
06/29/2011
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