Healthcare Provider Details

I. General information

NPI: 1780061911
Provider Name (Legal Business Name): MATTHEW JAMES HILLAM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 07/03/2021
Certification Date: 07/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 8TH AVE STE 6010
SPOKANE WA
99204-2341
US

IV. Provider business mailing address

105 W 8TH AVE STE 6010
SPOKANE WA
99204-2341
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-5950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR2997
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.012566
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOP61113295
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: