Provider Demographics
NPI:1083753925
Name:DWYER, MATTHEW MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:DWYER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1139 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4347
Mailing Address - Country:US
Mailing Address - Phone:210-545-7171
Mailing Address - Fax:210-545-7176
Practice Address - Street 1:1139 E SONTERRA BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4347
Practice Address - Country:US
Practice Address - Phone:210-545-7171
Practice Address - Fax:210-545-7176
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN5662207X00000X, 207XX0004X, 207XX0801X, 207XP3100X, 207XX0005X, 207XS0114X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB107036Medicare PIN