Provider Demographics
NPI:1134507387
Name:PADRICK, MATTHEW MAXIMILLIAN (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MAXIMILLIAN
Last Name:PADRICK
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 1:1600 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6400
Mailing Address - Country:US
Mailing Address - Phone:512-324-3540
Mailing Address - Fax:
Practice Address - Street 1:1600 W 38TH ST STE 308
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6406
Practice Address - Country:US
Practice Address - Phone:512-324-3540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX18892084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program