Provider Demographics
NPI:1467408039
Name:BLOEBAUM, R. MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:R. MATTHEW
Middle Name:
Last Name:BLOEBAUM
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 1:12606 W HOUSTON CENTER BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2790
Mailing Address - Country:US
Mailing Address - Phone:713-596-8526
Mailing Address - Fax:713-596-8560
Practice Address - Street 1:8955 HIGHWAY 6 N
Practice Address - Street 2:#100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2320
Practice Address - Country:US
Practice Address - Phone:281-858-5708
Practice Address - Fax:281-858-6339
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9628207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043645OtherBLUE LINK
TX3558990OtherCIGNA
TX171597101Medicaid
TX7912611OtherAETNA PPO
TX3687922OtherAETNA HMO
TX171597101Medicaid
TX8C8435Medicare PIN