Individual
DR. JACOB ALEX MATHEW VARGHESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19200 N KELSEY ST, MONROE, WA 98272-1431
(360) 794-7994
(360) 805-4757
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(866) 366-2983
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
57074561205
UT
208000000X
Pediatrics Physician
MD419174
PA
208000000X
Pediatrics Physician
Primary
MD60523725
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
942854057014
—
UT
05
—
942854058940
—
UT
Enumeration date
10/11/2006
Last updated
04/23/2021
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