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NPI Code Detail

MEDICARE: DR. JUSTIN MATTHEW DYNIEWSKI M.D.

MEDICARE: DR. JUSTIN MATTHEW DYNIEWSKI 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
12084P0804XChild & Adolescent Psychiatry PhysicianP2981TX
22084P0800XPsychiatry PhysicianP2981TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1TXB160581OTHERTXMEDICARE
3P01103934OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
58DK337OTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1588875827
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN MATTHEW DYNIEWSKI M.D.
Provider Business Mailing Address
First Line : 1527 HEMPHILL ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4706
Country : US
Telephone Number : 817-569-5900
Fax Number :
Provider Business Practice Location Address
First Line : 1527 HEMPHILL ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4706
Country : US
Telephone Number : 817-569-5900
Fax Number : 817-569-5998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2007
Last Update Date : 01/30/2026

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