Individual
MIGUEL BLAS-MATUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1515 E COLUMBIA ST, OTHELLO, WA 99344-9934
(509) 488-5256
(509) 488-9939
Mailing address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
(509) 488-9939
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60195247
WA
363A00000X
Physician Assistant
—
WA
Other
Enumeration date
10/22/2010
Last updated
03/23/2021
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