MEDICARE: MATTHEW GERALD KAUFMAN

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	208200000X	Plastic Surgery Physician	S0919	TX
2	208200000X	Plastic Surgery Physician	573664	TX

General Provider Information

NPI Number	:	1376988493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW GERALD KAUFMAN

Provider Business Mailing Address
First Line	:	6560 FANNIN ST STE 2200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2715
Country	:	US
Telephone Number	:	713-441-0023
Fax Number	:

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST STE 2200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2715
Country	:	US
Telephone Number	:	713-441-0023
Fax Number	:

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

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	01/03/2023

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