Provider Demographics
NPI:1427670520
Name:RAND, MATTHEW ALAN (PA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALAN
Last Name:RAND
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1793 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2541
Mailing Address - Country:US
Mailing Address - Phone:503-362-8385
Mailing Address - Fax:503-362-8435
Practice Address - Street 1:4407 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-9514
Practice Address - Country:US
Practice Address - Phone:360-457-0760
Practice Address - Fax:360-994-4975
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2024-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI5039-23363A00000X
WAPA61323159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant