MEDICARE: DAVID MATSON

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	183500000X	Pharmacist	28720	TX

General Provider Information

NPI Number	:	1487013538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MATSON

Provider Business Mailing Address
First Line	:	5401 PARK SPRINGS BLVD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-3418
Country	:	US
Telephone Number	:	817-466-0677
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 PARK SPRINGS BLVD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-3418
Country	:	US
Telephone Number	:	817-466-0677
Fax Number	:

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

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	02/17/2016

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