Healthcare Provider Details

I. General information

NPI: 1972086692
Provider Name (Legal Business Name): MATTHEW STUART CAREY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2018
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 TROSPER RD SW STE 118
TUMWATER WA
98512-7072
US

IV. Provider business mailing address

1313 BROADWAY FL 2
TACOMA WA
98402-3400
US

V. Phone/Fax

Practice location:
  • Phone: 360-763-7050
  • Fax:
Mailing address:
  • Phone: 253-403-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60996713
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: