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General NPI Number Information
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NPI Number | 1891124970
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Entity Type | Individual
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Provider Name | MOLLY ANNE MATTHEWS PAC
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Gender | Female
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 2900 STATE ST
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City | MEDFORD
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State | OR
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Zip | 97504-8458
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Country | US
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Telephone | 541-789-5790
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Fax | 541-789-5973
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Provider Business Mailing Address
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Address Line | 2825 E BARNETT RD # MSS
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City | MEDFORD
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State | OR
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Zip | 97504-8332
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Country | US
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Telephone | 541-789-4281
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Fax | 541-789-4806
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA205662
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA0003834
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License Number State | CO
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