Provider Demographics
NPI:1467613067
Name:FAY, MATT DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:DOUGLAS
Last Name:FAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4650 LAKE RIDGE PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-1908
Mailing Address - Country:US
Mailing Address - Phone:817-398-4300
Mailing Address - Fax:817-398-4301
Practice Address - Street 1:6035 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-5410
Practice Address - Country:US
Practice Address - Phone:817-398-4300
Practice Address - Fax:817-398-4301
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ4579207RI0011X, 207RI0011X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program