Provider Demographics
NPI:1164638920
Name:EBERLY, MATTHEW ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ROBERT
Last Name:EBERLY
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 1:909 N NAVARRO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6734
Mailing Address - Country:US
Mailing Address - Phone:361-576-2111
Mailing Address - Fax:
Practice Address - Street 1:909 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6734
Practice Address - Country:US
Practice Address - Phone:361-576-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN778213E00000X
TX3097213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN397D3EBOtherBCBS MN
MN091925100Medicaid
WI43242500Medicaid
MN139511OtherUCARE MN
MNHP79563OtherHEALTH PARTNERS
MN139511OtherUCARE MN
WI43242500Medicaid