Provider Demographics
NPI:1407858384
Name:MATORIN, PHILIP ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANDREW
Last Name:MATORIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12121 RICHMOND AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2420
Mailing Address - Country:US
Mailing Address - Phone:281-920-5558
Mailing Address - Fax:281-920-5568
Practice Address - Street 1:12121 RICHMOND AVE STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2420
Practice Address - Country:US
Practice Address - Phone:281-920-5558
Practice Address - Fax:281-920-5568
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0103207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86042ZOtherRENNAISANCE IPA
741800693OtherUNITED HEALTHCARE
TX183307101Medicaid
8V1030OtherBLUE CROSS
TX038176601Medicaid
741800693OtherUNITED HEALTHCARE
TX183307101Medicaid