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General NPI Number Information
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NPI Number | 1538788732
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Entity Type | Individual
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Provider Name | DYLAN SUPAK MATZKE
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Gender | Female
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 800 SCOTT AND WHITE DR
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City | COLLEGE STATION
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State | TX
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Zip | 77845-6440
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Country | US
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Telephone | 979-207-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 844658
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City | DALLAS
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State | TX
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Zip | 75284-4658
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Country | US
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Telephone | 800-994-0371
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Fax |
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | V9938
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License Number State | TX
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