Provider Demographics
NPI:1083980403
Name:ROBERTS, MATTHEW THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17685
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-7685
Mailing Address - Country:US
Mailing Address - Phone:281-491-6767
Mailing Address - Fax:281-565-1102
Practice Address - Street 1:16605 SOUTHWEST FWY STE 175
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-0003
Practice Address - Country:US
Practice Address - Phone:281-565-1112
Practice Address - Fax:281-565-1102
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278793207R00000X
TXR3413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400160510Medicare PIN