Provider Demographics
NPI:1497070379
Name:OLDEN, MATTHEW QUINN (RT (R),(T))
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:QUINN
Last Name:OLDEN
Suffix:
Gender:M
Credentials:RT (R),(T)
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:OLDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RT (R),(T)
Mailing Address - Street 1:4004 DORRIS RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-4003
Mailing Address - Country:US
Mailing Address - Phone:817-308-0268
Mailing Address - Fax:972-258-7972
Practice Address - Street 1:4004 DORRIS RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-4003
Practice Address - Country:US
Practice Address - Phone:817-308-0268
Practice Address - Fax:972-258-7972
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX199612471R0002X
2331212471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19961OtherTEXAS DEPARTMENT OF HEALTH
233121OtherAMERICAN REGISTRY RADIOLOGIC TECHNOLOGIST