MEDICARE: MATTHEW ISAKSON 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
1	208600000X	Surgery Physician	29829	OK
2	2086S0122X	Plastic and Reconstructive Surgery Physician	U3891	TX

General Provider Information

NPI Number	:	1144664970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ISAKSON MD

Provider Business Mailing Address
First Line	:	414 W SUNSET RD STE 215
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1771
Country	:	US
Telephone Number	:	210-920-7922
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 W SUNSET RD STE 215
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1771
Country	:	US
Telephone Number	:	210-920-7922
Fax Number	:

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

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	08/01/2023

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