Individual
TRAVIS MATSUMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
920 COUNTRY CLUB RD STE 200A, EUGENE, OR 97401-6086
(541) 242-4220
(541) 686-6021
Mailing address
920 COUNTRY CLUB RD STE 200A, EUGENE, OR 97401-6086
(541) 242-4220
(541) 686-6021
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA156342
—
363AS0400X
Surgical Physician Assistant
PA156342
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA156342
STATE LICENSE
OR
Enumeration date
02/01/2012
Last updated
10/31/2014
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