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NPI Code Detail

MEDICARE: MATTHEW PAUL CARLSON D.O.

MEDICARE: MATTHEW PAUL CARLSON D.O.
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
1207Q00000XFamily Medicine PhysicianDO185531OR
2207Q00000XFamily Medicine PhysicianOP61357925WA

General Provider Information

NPI Number : 1346561172
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW PAUL CARLSON D.O.
Provider Business Mailing Address
First Line : 550 GAGE BLVD STE 101
Second Line :
City : RICHLAND
State : WA
Zip : 99352-9532
Country : US
Telephone Number : 509-942-3627
Fax Number : 509-627-2983
Provider Business Practice Location Address
First Line : 940 NORTHGATE DR
Second Line :
City : RICHLAND
State : WA
Zip : 99352-3505
Country : US
Telephone Number : 509-942-2516
Fax Number : 509-942-2527
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2010
Last Update Date : 10/18/2022

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