Healthcare Provider Details

I. General information

NPI: 1124608500
Provider Name (Legal Business Name): MATTHEW KEEFER STURM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2021
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 GEORGIANA ST
PORT ANGELES WA
98362-3911
US

IV. Provider business mailing address

PO BOX 850
PORT ANGELES WA
98362-0146
US

V. Phone/Fax

Practice location:
  • Phone: 360-565-0999
  • Fax: 360-565-0852
Mailing address:
  • Phone: 360-565-0999
  • Fax: 360-565-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPTL8072
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA196554
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61576431
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: