Provider Demographics
NPI:1063645570
Name:TOMMACK, MATTHEW RYAN (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:TOMMACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-242-4384
Mailing Address - Fax:541-463-2820
Practice Address - Street 1:600 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2240
Practice Address - Country:US
Practice Address - Phone:541-242-4162
Practice Address - Fax:541-345-2358
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR51010184522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology