Provider Demographics
NPI:1366484735
Name:MATHEW, GEORGE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-4302
Mailing Address - Country:US
Mailing Address - Phone:360-775-3515
Mailing Address - Fax:855-919-5976
Practice Address - Street 1:618 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3812
Practice Address - Country:US
Practice Address - Phone:360-775-3515
Practice Address - Fax:855-919-5976
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033873207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00033873OtherMD LICENSE