MEDICARE: GEORGE PHILIP MATTHEWS MD

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	174400000X	Specialist	K0122	TX
2	207W00000X	Ophthalmology Physician	K0122	TX
3	207WX0107X	Retina Specialist (Ophthalmology) Physician	K0122	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922005396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE PHILIP MATTHEWS MD

Provider Business Mailing Address
First Line	:	1325 PENNSYLVANIA AVE STE 110
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2146
Country	:	US
Telephone Number	:	877-683-3702
Fax Number	:	469-484-6415

Provider Business Practice Location Address
First Line	:	1325 PENNSYLVANIA AVE STE 110
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2146
Country	:	US
Telephone Number	:	877-683-3702
Fax Number	:	469-484-6415

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	04/07/2017

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Directions to “ GEORGE PHILIP MATTHEWS MD” Practice Location

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