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General NPI Number Information
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NPI Number | 1891769329
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Entity Type | Individual
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Provider Name | MATTHEW AARON LAUDIE M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 3851 ROGER BROOKE DRIVE
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234
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Country | US
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Telephone | 210-916-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 10411 LION MOON
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City | SAN ANTONIO
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State | TX
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Zip | 78251-4134
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Country | US
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Telephone |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01059036A
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License Number State | IN
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