Healthcare Provider Details

I. General information

NPI: 1427167592
Provider Name (Legal Business Name): ALVIN M. MATSUMOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY VA PUGET SOUND HEALTH CARE SYSTEM (S-182-GRECC)
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

1660 S COLUMBIAN WAY VA PUGET SOUND HEALTH CARE SYSTEM (S-182-GRECC)
SEATTLE WA
98108-1532
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-2308
  • Fax: 206-764-2569
Mailing address:
  • Phone: 206-764-2308
  • Fax: 206-764-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00015733
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD00015733
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD00015733
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: