MEDICARE: GINA MATEER R.D., L.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	133V00000X	Registered Dietitian	DT81885	TX

General Provider Information

NPI Number	:	1225456528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MATEER R.D., L.D.

Provider Business Mailing Address
First Line	:	2317 S 3RD ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-5025
Country	:	US
Telephone Number	:	832-439-6534
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 N LAMAR BLVD STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-4920
Country	:	US
Telephone Number	:	512-814-8255
Fax Number	:

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

Provider Enumeration Date	:	04/03/2014
Last Update Date	:	12/03/2016

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