Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | K7206 | TX |
N | 207QG0300X | Family Doctor - Geriatric Medicine | K7206 | TX |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | K7206 | TX |
NPI | 1568482768 |
---|---|
Provider Name | Dr. Matthew L Rios |
First Address | Fort Worth, TX 76104-4917 |
Second Address | Fort Worth, TX 76104-4917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 07/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105350606 | (05) | TX |
H07521 | (02) | TX |