Healthcare Provider Details

I. General information

NPI: 1316055247
Provider Name (Legal Business Name): ROY PAUL MATHEWS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 TERRY AVE
SEATTLE WA
98101-2747
US

IV. Provider business mailing address

10618 NE 155TH PL
BOTHELL WA
98011-5770
US

V. Phone/Fax

Practice location:
  • Phone: 206-922-6500
  • Fax:
Mailing address:
  • Phone: 206-437-2549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOP00001488
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: