Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | Q6528 | TX |
NPI | 1215348404 |
---|---|
Provider Name | Alexandra Stephanie Matthews |
First Address | San Antonio, TX 78258-4352 |
Second Address | San Antonio, TX 78258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2014 |
Last Update Date | 07/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
354153402 | (05) | TX |