Provider Demographics
NPI:1144226036
Name:MATTHEWS, FREDERICK L (DPM)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:L
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 OLD SHEPARD PL STE 260
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5250
Mailing Address - Country:US
Mailing Address - Phone:314-741-3546
Mailing Address - Fax:314-741-3548
Practice Address - Street 1:5072 W PLANO PKWY
Practice Address - Street 2:STE 220
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4475
Practice Address - Country:US
Practice Address - Phone:469-671-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006070-1213ES0103X
IL016.005325213ES0103X
MO2005012314213ES0103X
TX2186213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02646977Medicaid
PJ8251OtherMEDICARE PROVIDER
BM9133846OtherDEA
NY02646977Medicaid