Healthcare Provider Details

I. General information

NPI: 1013849207
Provider Name (Legal Business Name): DAVID MATSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 SE 55TH AVE
PORTLAND OR
97215-2655
US

IV. Provider business mailing address

941 SE 55TH AVE
PORTLAND OR
97215-2655
US

V. Phone/Fax

Practice location:
  • Phone: 510-289-2268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: