MEDICARE: MATTHEW VAN NORMAN DO

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	207RN0300X	Nephrology Physician	S1722	TX

General Provider Information

NPI Number	:	1164877445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW VAN NORMAN DO

Provider Business Mailing Address
First Line	:	6431 FANNIN ST # 5.134
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6431 FANNIN ST STE MSB 5134
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-500-6868
Fax Number	:	713-500-6882

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

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	08/22/2024

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