Healthcare Provider Details

I. General information

NPI: 1154368322
Provider Name (Legal Business Name): ROBERT CHARLES MATTHEWS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 NC HIGHWAY 242 N
BENSON NC
27504-7844
US

IV. Provider business mailing address

400 W PLUMMER ST
EASTLAND TX
76448-2627
US

V. Phone/Fax

Practice location:
  • Phone: 254-629-1744
  • Fax: 254-629-3904
Mailing address:
  • Phone: 254-629-1744
  • Fax: 254-629-3904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number201902816
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: