Basic Information
| Provider Information | |||||||||
| NPI: | 1730440058 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATLER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2478 13TH ST. SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973022546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033622481 | ||||||||
| FaxNumber: | 5033758700 | ||||||||
| Practice Location | |||||||||
| Address1: | 2478 13TH ST. SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973022546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033622481 | ||||||||
| FaxNumber: | 5033758700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2012 | ||||||||
| LastUpdateDate: | 09/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD189218 | OR | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 78003 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 500745664 | 05 | OR | MEDICAID |