Provider Demographics
NPI:1285291047
Name:MATIACO, PAUL M (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:MATIACO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-2516
Mailing Address - Fax:509-942-2527
Practice Address - Street 1:3950 KEENE RD
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-4901
Practice Address - Country:US
Practice Address - Phone:509-942-3130
Practice Address - Fax:509-628-8335
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2024-08-12
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Provider Licenses
StateLicense IDTaxonomies
WAOP61192427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine