Provider Demographics
NPI:1487673935
Name:WINDROW, MATTHEW JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:WINDROW
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:PO BOX 858
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-0858
Mailing Address - Country:US
Mailing Address - Phone:830-741-3054
Mailing Address - Fax:830-741-6290
Practice Address - Street 1:3200 AVENUE E
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861
Practice Address - Country:US
Practice Address - Phone:830-741-3054
Practice Address - Fax:830-741-6290
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0001EPOtherBCBS ID
TX135194203Medicaid
TX135194205Medicaid
TX8J0362OtherBCBS ID
G77888Medicare UPIN