MEDICARE: MATTHEW ALAN RAND PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5039-23	WI
2	363A00000X	Physician Assistant	PA61323159	WA

General Provider Information

NPI Number	:	1427670520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ALAN RAND PA

Provider Business Mailing Address
First Line	:	1793 13TH ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-2541
Country	:	US
Telephone Number	:	503-362-8385
Fax Number	:	503-362-8435

Provider Business Practice Location Address
First Line	:	4407 FAIRMOUNT AVE
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-9514
Country	:	US
Telephone Number	:	360-457-0760
Fax Number	:	360-994-4975

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2020
Last Update Date	:	10/15/2024

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