Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | F7835 | TX |
NPI | 1033118021 |
---|---|
Provider Name | Douglas Andrew Matey JR. |
First Address | Kerrville, TX 78029-1411 |
Second Address | Kerrville, TX 78028-9515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40047644 | TX DPS # (01) | TX |
8M8100 | BLUE CROSS - BLUE SHIELD (01) | TX |
AM1290802 | DEA # (01) | TX |
C18930 | (02) | TX |
F7835 | TEXAS MEDICAL LICENSE (01) | TX |