Healthcare Provider Details

I. General information

NPI: 1639122591
Provider Name (Legal Business Name): MATTHEW LONERGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 COUNTRY CLUB
EUGENE OR
97401-6036
US

IV. Provider business mailing address

520 COUNTRY CLUB PKWY
EUGENE OR
97401-6043
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-5001
  • Fax: 541-683-1422
Mailing address:
  • Phone: 415-683-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00034123
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD00034123
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD171696
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1639122591
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier900004086
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerRAILROAD MEDICARE
# 3
Identifier0291409
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerL&I

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: