Provider Demographics
NPI:1053633107
Name:WEYHE, MATTHEW RANDALL (CNIM)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RANDALL
Last Name:WEYHE
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HIGHLAND PARK VLG
Mailing Address - Street 2:STE 100-225
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-2789
Mailing Address - Country:US
Mailing Address - Phone:214-536-1647
Mailing Address - Fax:214-580-7600
Practice Address - Street 1:25 HIGHLAND PARK VLG
Practice Address - Street 2:STE 100-225
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-2789
Practice Address - Country:US
Practice Address - Phone:214-536-1647
Practice Address - Fax:214-580-7600
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1911246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic