Provider Demographics
NPI:1205840006
Name:MAHOWALD, MATTHEW R (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:MAHOWALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3300 OAK LAWN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4236
Mailing Address - Country:US
Mailing Address - Phone:214-252-3501
Mailing Address - Fax:214-252-0524
Practice Address - Street 1:3300 OAK LAWN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4236
Practice Address - Country:US
Practice Address - Phone:214-252-3501
Practice Address - Fax:214-252-0524
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN2636207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology