| Gary L Matson Do Inc | |
|
4501 Mission Bay Dr 3e San Diego CA 92109 | |
| (858) 270-4343 | |
| (858) 272-1731 |
| Full Name | Gary L Matson Do Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 4501 Mission Bay Dr 3e, San Diego, California |
| Authorized Official Name and Position | Gary L Matson (OWNER/PRESIDENT) |
| Authorized Official Contact | 8582704343 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary L Matson Do Inc 4501 Mission Bay Dr 3e San Diego CA 92109 Ph: (858) 270-4343 | Gary L Matson Do Inc 4501 Mission Bay Dr 3e San Diego CA 92109 Ph: (858) 270-4343 |
| NPI Number | 1225357833 |
|---|---|
| Provider Enumeration Date | 05/21/2010 |
| Last Update Date | 05/21/2010 |
| Medicare PECOS PAC ID | 0042349870 |
|---|---|
| Medicare Enrollment ID | O20100603000487 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225357833 | NPI | - | NPPES |
| 00AX62631 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A6263 (California) | Primary |
| Provider Name | Gary L Matson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154344695 PECOS PAC ID: 4486781036 Enrollment ID: I20100429001150 |
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