Healthcare Provider Details

I. General information

NPI: 1508363318
Provider Name (Legal Business Name): MATTHEW STEGMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 07/12/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 BROADWAY
SEATTLE WA
98102
US

IV. Provider business mailing address

PO BOX 34490
SEATTLE WA
98124-1490
US

V. Phone/Fax

Practice location:
  • Phone: 206-329-1760
  • Fax:
Mailing address:
  • Phone: 206-329-1760
  • Fax:

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 State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA165713
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD61511329
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: