Healthcare Provider Details

I. General information

NPI: 1992797799
Provider Name (Legal Business Name): MATTHEW M HAND PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S FLEISHEL AVE SUITE 101
TYLER TX
75701-2004
US

IV. Provider business mailing address

3200 QUAIL SPRINGS PKWY SUITE 200
OKLAHOMA CITY OK
73134-2604
US

V. Phone/Fax

Practice location:
  • Phone: 903-595-5514
  • Fax: 903-262-3702
Mailing address:
  • Phone: 405-701-9880
  • Fax: 405-701-9881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2557
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: