Provider Demographics
NPI:1114036928
Name:ADAMSON, MATTHEW MACDONALD (NP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:MACDONALD
Last Name:ADAMSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:107 RIDGE OAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154
Mailing Address - Country:US
Mailing Address - Phone:972-617-1288
Mailing Address - Fax:
Practice Address - Street 1:4500 SOUTH LANCASTER
Practice Address - Street 2:CARDIOLOGY 111A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216
Practice Address - Country:US
Practice Address - Phone:214-857-1578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX613101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXVAD000Medicare UPIN