Provider Demographics
NPI:1124608500
Name:STURM, MATTHEW KEEFER (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:KEEFER
Last Name:STURM
Suffix:
Gender:M
Credentials:MD
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 850
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0146
Mailing Address - Country:US
Mailing Address - Phone:360-565-0999
Mailing Address - Fax:360-565-0852
Practice Address - Street 1:907 GEORGIANA ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3911
Practice Address - Country:US
Practice Address - Phone:360-565-0999
Practice Address - Fax:360-565-0852
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTL8072207Q00000X
CAA196554207Q00000X
CA390200000X
WAMD61576431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program