MEDICARE: DR. MATT TED GUBERT M.D.

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
1	207L00000X	Anesthesiology Physician	L7402	TX

General Provider Information

NPI Number	:	1144263484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATT TED GUBERT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 678631
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75267-8631
Country	:	US
Telephone Number	:	972-588-4541
Fax Number	:	469-304-0139

Provider Business Practice Location Address
First Line	:	400 CHISHOLM PL STE 406
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-6911
Country	:	US
Telephone Number	:	972-588-4541
Fax Number	:	469-304-0139

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/01/2020

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