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NPI Code Detail

MEDICARE: JACQUIN P MATTHEWS MD

MEDICARE: JACQUIN P MATTHEWS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianJ4909TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00007979OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073536017
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUIN P MATTHEWS MD
Provider Business Mailing Address
First Line : PO BOX 961205
Second Line :
City : FORT WORTH
State : TX
Zip : 76161-1205
Country : US
Telephone Number : 817-740-8400
Fax Number : 817-870-1818
Provider Business Practice Location Address
First Line : 851 W TERRELL AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3161
Country : US
Telephone Number : 817-870-1551
Fax Number : 817-870-1818
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 10/14/2011

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