Provider Demographics
NPI:1215071469
Name:MCLAUGHLIN, MATTHEW DAVID (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 W IRONWOOD DR
Mailing Address - Street 2:STE 104
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2668
Mailing Address - Country:US
Mailing Address - Phone:208-667-0621
Mailing Address - Fax:208-664-1709
Practice Address - Street 1:980 W IRONWOOD DR
Practice Address - Street 2:STE 104
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2668
Practice Address - Country:US
Practice Address - Phone:208-667-0621
Practice Address - Fax:208-664-1709
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0434208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807786900Medicaid
ID1303427Medicare Oscar/Certification