MEDICARE: DR. PHILIP ANDREW MATORIN M.D.

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	207Y00000X	Otolaryngology Physician	J0103	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86042Z	OTHER	TX	RENNAISANCE IPA
2	741800693	OTHER		UNITED HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8V1030	OTHER		BLUE CROSS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407858384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP ANDREW MATORIN M.D.

Provider Business Mailing Address
First Line	:	12121 RICHMOND AVE STE 104
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2420
Country	:	US
Telephone Number	:	281-920-5558
Fax Number	:	281-920-5568

Provider Business Practice Location Address
First Line	:	12121 RICHMOND AVE STE 104
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2420
Country	:	US
Telephone Number	:	281-920-5558
Fax Number	:	281-920-5568

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	04/26/2021

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