Provider Demographics
NPI:1609801646
Name:MATTHEWS, LINDA FONSECA (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:FONSECA
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:FONSECA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:801 W 34TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1157
Mailing Address - Country:US
Mailing Address - Phone:512-459-1131
Mailing Address - Fax:
Practice Address - Street 1:1950 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3129
Practice Address - Country:US
Practice Address - Phone:303-678-4812
Practice Address - Fax:303-678-4812
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7379207V00000X, 207VM0101X
CODR.0062096207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166111801Medicaid
TX8H3603OtherBCBS
TXI11331Medicare UPIN
TX166111801Medicaid