Healthcare Provider Details

I. General information

NPI: 1689969974
Provider Name (Legal Business Name): MATTHEW DAVID MRAZEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 NORTH LOOP WEST SOUTH TOWER
HOUSTON TX
77008
US

IV. Provider business mailing address

909 FROSTWOOD DR STE 1.100
HOUSTON TX
77024-2301
US

V. Phone/Fax

Practice location:
  • Phone: 713-314-8280
  • Fax: 713-867-2066
Mailing address:
  • Phone: 713-338-6353
  • Fax: 409-772-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ3059
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberQ3059
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: