Healthcare Provider Details

I. General information

NPI: 1174546295
Provider Name (Legal Business Name): H PRESTON MATTHEWS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PRESTON H MATTHEWS

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 JUAN TABO BLVD NE
ALBUQUERQUE NM
87112-3307
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA83286
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: