=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679572671
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOUGLAS A. MATEY, JR., M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1331 BANDERA HWY SUITE 3
-----------------------------------------------------
City | KERRVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78028-9515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-792-6860
-----------------------------------------------------
Fax | 830-792-3738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 291411
-----------------------------------------------------
City | KERRVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78029-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-792-6860
-----------------------------------------------------
Fax | 830-792-3738
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DOUGLAS A. MATEY JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 830-792-6860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------