Provider Demographics
NPI:1093342107
Name:GILLINGS, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GILLINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-9702
Mailing Address - Country:US
Mailing Address - Phone:254-756-4457
Mailing Address - Fax:254-756-1718
Practice Address - Street 1:2400 AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-9702
Practice Address - Country:US
Practice Address - Phone:254-756-4457
Practice Address - Fax:254-756-1718
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10074518207W00000X
390200000X
TXU8723207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program