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General NPI Number Information
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NPI Number | 1417020744
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Entity Type | Individual
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Provider Name | MATTEETHRA CHANDY JACOB M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 8520 KNIGHT ROAD
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City | HOUSTON
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State | TX
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Zip | 77054-3808
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Country | US
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Telephone | 713-790-1335
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Fax | 713-797-1858
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Provider Business Mailing Address
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Address Line | 8520 KNIGHT RD
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City | HOUSTON
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State | TX
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Zip | 77054-3808
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Country | US
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Telephone | 713-961-4962
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Fax | 713-355-7991
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | F2730
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License Number State | TX
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