Healthcare Provider Details

I. General information

NPI: 1720435571
Provider Name (Legal Business Name): MATTHEW MICHAEL HESSEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DRIVE - EMERGENCY MEDICINE DEPARTMENT JBSA-FORT SAM HOUSTON
SAN ANTONIO TX
78234-4504
US

IV. Provider business mailing address

3551 ROGER BROOKE DRIVE - EMERGENCY MEDICINE DEPARTMENT JBSA-FORT SAM HOUSTON
SAN ANTONIO TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-9157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberBP10057610
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: