Healthcare Provider Details

I. General information

NPI: 1487723532
Provider Name (Legal Business Name): KARL FREDERIC MATOUS IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSRON 9 NAVAL STATION EVERETT 2000 MARINE VIEW DRIVE BUILDING 2134
EVERETT WA
98207-0001
US

IV. Provider business mailing address

MSRON 9 NAVAL STATION EVERETT 2000 MARINE VIEW DRIVE BUILDING 2134
EVERETT WA
98207-0001
US

V. Phone/Fax

Practice location:
  • Phone: 425-304-4790
  • Fax: 425-304-4798
Mailing address:
  • Phone: 425-304-4790
  • Fax: 425-304-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: