MEDICARE: EDUARDO J MATTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	M7409	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	187016403	OTHER	TX	CSHCN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8W2049	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1235248964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO J MATTA MD

Provider Business Mailing Address
First Line	:	PO BOX 301173
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75303-1173
Country	:	US
Telephone Number	:	713-500-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-704-4000
Fax Number	:	713-704-5734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	12/23/2025

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