MEDICARE: MATTHEW DAVID WHITSON

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	363LF0000X	Family Nurse Practitioner	1177295	TX

General Provider Information

NPI Number	:	1659188209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW DAVID WHITSON

Provider Business Mailing Address
First Line	:	11602 ELIJAH STAPP
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-5570
Country	:	US
Telephone Number	:	210-315-2444
Fax Number	:

Provider Business Practice Location Address
First Line	:	7430 LOUIS PASTEUR DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4507
Country	:	US
Telephone Number	:	210-949-2000
Fax Number	:

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

Provider Enumeration Date	:	12/17/2024
Last Update Date	:	12/17/2024

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