Provider Demographics
NPI:1578206017
Name:MATTHEWS, ANDREW RYAN
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:RYAN
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 CUMNOR RD APT 205
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-6303
Mailing Address - Country:US
Mailing Address - Phone:713-828-8790
Mailing Address - Fax:
Practice Address - Street 1:525 CUMNOR RD APT 205
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6303
Practice Address - Country:US
Practice Address - Phone:713-828-8790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program