MEDICARE: DR. RAY VERN MATTHEWS M.D.

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	174400000X	Specialist	G54794	CA
2	207RC0000X	Cardiovascular Disease Physician	G54794	CA
3	207RI0011X	Interventional Cardiology Physician	G54794	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	060049073	OTHER	CA	MEDICARE RAILROAD
2	W18762	OTHER	CA	GROUP MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	GR0100430	OTHER	CA	GROUP MEDICAL
5	1902846306	OTHER	CA	GROUP NPI

General Provider Information

NPI Number	:	1104810076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAY VERN MATTHEWS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 31309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-0309
Country	:	US
Telephone Number	:	323-442-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 SAN PABLO ST
Second Line	:	SUITE 1000
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5310
Country	:	US
Telephone Number	:	323-442-5100
Fax Number	:

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	11/27/2023

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Directions to “ DR. RAY VERN MATTHEWS M.D.” Practice Location

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