MEDICARE: DR. MATTHEW TIMOTHY MCEWAN 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
1	208VP0014X	Interventional Pain Medicine Physician	DO.1957	AL
2	208VP0014X	Interventional Pain Medicine Physician	OS15925	FL
3	208VP0014X	Interventional Pain Medicine Physician	OP61109043	WA

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	:	1699114025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW TIMOTHY MCEWAN D.O.

Provider Business Mailing Address
First Line	:	11306 BRIDGEPORT WAY SW STE D
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11306 BRIDGEPORT WAY SW STE D
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3037
Country	:	US
Telephone Number	:	253-983-9390
Fax Number	:

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

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	07/13/2023

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