MEDICARE: MATTHEW THOMAS JAMES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	60188639	WA

General Provider Information

NPI Number	:	1023326386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW THOMAS JAMES PA-C

Provider Business Mailing Address
First Line	:	121 RESOLUTE LN
Second Line	:
City	:	PORT LUDLOW
State	:	WA
Zip	:	98365-9617
Country	:	US
Telephone Number	:	360-301-9423
Fax Number	:

Provider Business Practice Location Address
First Line	:	234511 HWY 101 WEST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-2412
Country	:	US
Telephone Number	:	360-452-6252
Fax Number	:	360-452-6274

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	08/06/2016

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