Individual
MARK S MATHEWS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
700 SLEATER KINNEY RD SE, PMB 254, LACEY, WA 98503-1150
(360) 426-8398
(360) 426-0413
Mailing address
700 SLEATER KINNEY RD SE, PMB 254, LACEY, WA 98503-1113
(360) 426-8398
(360) 426-0413
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA1002175
WA
Other
Enumeration date
06/14/2006
Last updated
07/09/2007
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