Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | M4196 | TX |
NPI | 1346287877 |
---|---|
Provider Name | Dr. Matthew James Isom |
First Address | Pearland, TX 77584-7298 |
Second Address | Katy, TX 77449-2853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 08/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
212118806 | (05) | TX |
212118807 | (05) | TX |
212118808 | (05) | TX |
8CJ867 | BC/BS OF TEXAS (01) | TX |