Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DE60143704 | WA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | MD61048195 | WA |
NPI | 1093055097 |
---|---|
Provider Name | Dr. Matthew Thomas Streelman |
First Address | Oklahoma City, OK 73124-8986 |
Second Address | Mercer Island, WA 98040-6014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2013 |
Last Update Date | 17/12/2021 |