Matthew Willard, PA-C – Physician Assistant

Key facts

NPI: 1336360304
Entity type: Individual (NPI type 1)
Primary specialty: Physician Assistant 363A00000X
License: 629 (AK)
Practice address: 1 Toksook Bay Sub-Regional Clinic
Toksook Bay, AK 99637
Phone: (907) 543-6300
NPI assigned: May 1, 2007
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
629	AK	MD	Physician Assistant

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physician Assistant	363A00000X	629	AK	Yes

Addresses

Primary practice location

1 Toksook Bay Sub-Regional Clinic
Toksook Bay, AK 99637

Mailing address

PO Box 37028
Toksook Bay, AK 99637
Phone (907) 427-3500

Other identifiers

Identifier	Type	State	Issuer
MDA0196	Medicaid	AK

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 7, 2010.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283817600000",
    "number": "1336360304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37028",
            "city": "TOKSOOK BAY",
            "state": "AK",
            "postal_code": "99637",
            "telephone_number": "907-427-3500",
            "fax_number": "907-427-3526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 TOKSOOK BAY SUB-REGIONAL CLINIC",
            "city": "TOKSOOK BAY",
            "state": "AK",
            "postal_code": "99637",
            "telephone_number": "907-543-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLARD",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2010-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MDA0196",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Toksook Bay, AK

All providers in Toksook Bay, AK · Physician Assistant in Alaska

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.