MEDICARE: MS. ANDREA LORAN MATSUMURA MD

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician	MD22819	OR
2	207R00000X	Internal Medicine Physician	MD22819	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487761136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA LORAN MATSUMURA MD

Provider Business Mailing Address
First Line	:	PO BOX 8459
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97207-8459
Country	:	US
Telephone Number	:	503-238-0769
Fax Number	:

Provider Business Practice Location Address
First Line	:	3036 NE MLK JR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-3053
Country	:	US
Telephone Number	:	503-283-3763
Fax Number	:

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	09/09/2024

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