Healthcare Provider Details

I. General information

NPI: 1720370943
Provider Name (Legal Business Name): MATTHEW R SCHLOUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

306 23RD AVE S STE 200 IORA PRIMARY CARE
SEATTLE WA
98144-2371
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-1111
  • Fax:
Mailing address:
  • Phone: 206-518-9058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60396546
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2019-0521
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: