Provider Demographics
NPI:1487723532
Name:MATOUS, KARL FREDERIC (IDC)
Entity type:Individual
Prefix:MR
First Name:KARL
Middle Name:FREDERIC
Last Name:MATOUS
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:MSRON 9 NAVAL STATION EVERETT
Mailing Address - Street 2:2000 MARINE VIEW DRIVE BUILDING 2134
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98207-0001
Mailing Address - Country:US
Mailing Address - Phone:425-304-4790
Mailing Address - Fax:425-304-4798
Practice Address - Street 1:MSRON 9 NAVAL STATION EVERETT
Practice Address - Street 2:2000 MARINE VIEW DRIVE BUILDING 2134
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98207-0001
Practice Address - Country:US
Practice Address - Phone:425-304-4790
Practice Address - Fax:425-304-4798
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman