Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD00012229 | WA |
NPI | 1023193836 |
---|---|
Provider Name | Frederick A Matsen III |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-6500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 06/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0231531 | L&I (01) | WA |
1023193836 | (05) | WA |
9113 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
A05105 | (02) |