MEDICARE: MATHEW ROY

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	AP130598	TX

General Provider Information

NPI Number	:	1801243779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATHEW ROY

Provider Business Mailing Address
First Line	:	2175 E SOUTHLAKE BLVD
Second Line	:	STE 120
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6544
Country	:	US
Telephone Number	:	817-813-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 E STATE HIGHWAY 114
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6510
Country	:	US
Telephone Number	:	817-442-5698
Fax Number	:

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

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	01/24/2022

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Directions to “ MATHEW ROY ” Practice Location

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