Healthcare Provider Details

I. General information

NPI: 1730356858
Provider Name (Legal Business Name): MATTHEW SCOTT WHITACRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FORT ST
NEAH BAY WA
98357-0410
US

IV. Provider business mailing address

243511 W HIGHWAY 101 250 FORT ST
PORT ANGELES WA
98363-9472
US

V. Phone/Fax

Practice location:
  • Phone: 360-645-2233
  • Fax: 360-645-2305
Mailing address:
  • Phone: 360-452-6252
  • Fax: 360-452-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60106651
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD60106651
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: